Analysis of Lung Cancer Screening Eligibility Among Patients Diagnosed With Lung Cancer: A Retrospective Cohort Study
TL;DR
Two critical barriers to effective lung cancer screening are emphasized: the limited reach of existing eligibility criteria and inadequate uptake of low-dose CT.
Abstract
Purpose: We evaluated lung cancer screening (LCS) eligibility rate under US Preventive Services Task Force (USPSTF) criteria among patients diagnosed with primary lung cancer and examined LCS utilization before lung cancer diagnosis. Methods: Patients aged 50 to 80 years with a lung cancer diagnosis in 2018–2024 who received care at a tertiary health system in Southern California were included. LCS eligibility was determined using available structured smoking history in the electronic medical record. The primary outcome was LCS eligibility using 2021 USPSTF guidelines. Secondary outcomes included low-dose CT (LDCT) completion among LCS-eligible patients during the 2 years preceding their diagnosis based on USPSTF guideline in effect at diagnosis time, the completeness of electronic medical record structured smoking history, and the associations between sociodemographic characteristics and these outcomes. Results: In all, 1,867 patients were included (mean age 67 ± 8 years, 51.6% [962 of 1,866] male, 53.4% [955 of 1,790] White, 2.4% [43 of 1,790] Black, 31.5% [564 of 1,790] Asian). Further, 11.6% (208 of 1,786) were Hispanic. At diagnosis, 46.3% (786 of 1,697) were never smokers, 44.5% (756 of 1,697) were former smokers, and 9.1% (155 of 1,697) were current smokers. LCS eligibility was determined for 1,119 patients, of whom 13.2% (148 of 1,119) met eligibility criteria according to the 2021 USPSTF guidelines. Multivariable analysis showed women (odds ratio [OR] 0.32; 95% confidence interval [CI], 0.21–0.47; P < .001), Asian race (OR 0.35; 95% CI, 0.20–0.62; P < .001), other or mixed race (OR 0.48; 95% CI, 0.24–0.97; P = .04), and Hispanic ethnicity (OR 0.38; 95% CI, 0.17–0.82; P = .01) were less likely to be LCS-eligible. Among the 137 eligible patients, only 13 (9.5%) had received LDCT. Conclusion: Our findings emphasize two critical barriers to effective LCS: the limited reach of existing eligibility criteria and inadequate uptake of LDCT.