Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis

Abstract

INTRODUCTION Lung cancer is the leading cause of cancer-related death in the U.S. The National Lung Screening Trial found that low-dose computed tomography reduced lung cancer mortality in high-risk individuals. As a result, the U.S. Preventive Services Task Force began recommending low-dose computed tomography screening for those at a high risk in 2013. Therefore, it is imperative to continually monitor lung cancer screening uptake. The objective of this study was to determine computed tomography screening uptake across ten states using 2017 Behavioral Risk Factor Surveillance System survey data. METHODS In fall 2018, a cross-sectional analysis was performed on survey data from 4,374 low-dose computed tomography-eligible participants, as determined by Task Force recommendations. Weighted percentages were calculated to assess computed tomography screening utilization overall and by state, sociodemographic, and clinical characteristics; Wald chi-squared tests evaluated group differences. RESULTS Within the study sample, 14.4% of eligible individuals had a computed tomography scan to test for lung cancer within the past 12 months. Significant state-to-state variation was identified (6.5% utilization in Nevada to 18.1% in Florida, p=0.03). Screening utilization was higher among individuals with insurance than among the uninsured (15.2% vs 4.0%, p<0.001), and it was higher among individuals with asthma (22.9% vs 12.9%, p=0.006) or chronic obstructive pulmonary disease (23.7% vs 8.5%, p<0.001) than among those without either condition. CONCLUSIONS Computed tomography screening utilization was higher than in earlier estimates. However, further research is needed to elucidate geographic variation in screening.