Prevalence of Lung Cancer Screening Among Eligible Adults in 4 US States in 2021

Introduction

Despite recommendations from the US Preventive Services Task Force (USPSTF) endorsing lung cancer screening (LCS), data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) showed that 12.8% of eligible adults received a computed tomographic (CT) scan to check for lung cancer.¹ Screening rates declined during the COVID-19 pandemic.² Increasing LCS among eligible adults is a national priority.³ We estimated LCS using data from the 2021 BRFSS and examined factors associated with LCS.

Methods

The 2021 BRFSS⁴ data were collected from January 2021 through January 2022; 4 states (Maine, Michigan, New Jersey, and Rhode Island) are included the LCS module. We included adults aged 55 to 79 years with at least a 30-pack-year smoking history who currently smoked or quit within the past 15 years (eMethods in Supplement 1).⁵ We excluded respondents who reported a history of lung cancer. The study was exempt from institutional review board oversight and informed consent by the Common Rule given its use of publicly available data. We followed the STROBE reporting guideline.

We calculated the percentage and 95% CIs of eligible respondents who reported receiving a CT scan for LCS and conducted χ² tests to assess statistically significant differences across demographic categories and subgroups based on lung cancer risk. We also examined factors associated with LCS using multivariable hierarchical logistic regression and reported odds ratios (ORs). We used the survey package in R, version 4.2.1 (The R Project) to account for the data design, with a 2-sided P < .05 considered significant.

Results

The weighted sample included 112 399 respondents who underwent LCS (mean [SD] age, 65.7 [5.8] years); 49.5% were males and 50.5% were females and 86.7% were White. Prevalence of LCS was 21.2%, an increase of 8.4% from 2019.¹ Respondents who underwent LCS reported a high pack-year smoking history (mean [SD], 57.3 [49.6] pack-years; 95% CI, 50.8-63.8 pack-years). The mean (SD) time since quitting was 6.9 (4.6) years (95% CI, 5.8-8.0 years) (Table 1). Of respondents who underwent LCS, 4.5% (95 CI, −4.5% to 13.5%) had no health insurance and 27.7% (95% CI, 16.0%-39.5%) reported poor health.

Multivariable hierarchical logistic regression analysis (Table 2) showed a higher likelihood of LCS for respondents in Rhode Island compared with Maine (OR, 1.96 [95% CI, 1.05-3.67]; P = .03). Compared with White respondents, the likelihood of LCS was higher for those who self-reported belonging to racial and ethnic groups other than White, Black, Hispanic, or multiracial (OR, 8.89 [95% CI, 1.81-43.71]; P = .01). Respondents who reported having a primary health professional (PHP) had a higher likelihood of LCS compared with those without a PHP (OR, 5.62 [95% CI, 1.19-26.49]; P = .03). Compared with respondents aged 65 to 77 years, the likelihood of obtaining LCS was lower for those aged 55 to 64 years (OR, 0.43 [95% CI. 0.23-0.81]; P = .01) and those aged 78 to 79 years (OR, 0.17 [95% CI, 0.04-0.80]; P = .02).

Discussion

The prevalence of LCS in 2021 rebounded to higher levels than in 2019. However, LCS rates remain lower than other population-level cancer screening programs.⁵ Consistent with prior studies, LCS uptake varied between states. Having a PHP was associated with higher likelihood of LCS, and our findings highlight the potential importance of Medicare coverage for LCS. Limitations of this analysis include use of self-reported data that were collected in only 4 states.

Disparities in LCS uptake among eligible adults remain and will likely continue with the updated USPSTF recommendation increases the number of Black adults who are eligible for LCS.⁵ Research to identify facilitators for LCS among persons who currently smoke is needed, including a focus on the role of stigma as a barrier to screening.^5,6 Finally, the high percentage of LCS in persons who reported poor health is concerning as many may not be healthy enough for treatment of lung cancer.