Baseline prevalence of lung cancer screening and associated factors among women in breast cancer screening clinics prior to the Pink & Pearl program: A retrospective analysis of electronic health records
TL;DR
The need for strategies to improve smoking history documentation and promote tobacco cessation efforts in cancer screening programs is highlighted and the Pink & Pearl program, a co-located breast and lung cancer screening initiative at these sites, will be evaluated.
Abstract
Abstract Introduction: Lung cancer screening (LCS) remains underutilized, with 18% uptake nationally, despite established evidence-based guidelines, particularly among women who engage with preventive care through breast cancer screening (BCS). We characterized baseline LCS uptake and its correlates among women receiving BCS at two participating hospitals. Methods We conducted a retrospective cohort study using six years of electronic health record data (October 2019–November 2025) from Barnes-Jewish West County Hospital and Christian Hospital. Women aged 50–80 with any documented smoking history were included. The primary outcome was LCS uptake, defined as evidence of at least one low-dose computed tomography scan. We conducted multivariable logistic regression models and assessed for effect modification by race and area deprivation using likelihood ratio tests. Results Of 9,686 women with smoking history, 3,209 (33.1%) had received at least one LCS. Pack-year documentation status (AOR 2.90; 95% CI: 2.63, 3.19), tobacco cessation medication use (AOR 2.21; 95% CI: 1.98, 2.48), and current smoking (AOR 1.84; 95% CI: 1.64, 2.07) were the factors most strongly associated with uptake. Non-Hispanic Black women had lower adjusted odds of obtaining LCS compared to non-Hispanic White women (AOR 0.87; 95% CI: 0.78, 0.98); estimates in the smaller pack-year subgroups were similar in direction but imprecise. Alcohol use was associated with lower odds of LCS uptake (0.81, 95% CI: 0.73, 0.89). Effect modification by race and area deprivation were not significant. Conclusions Baseline LCS uptake exceeded the national average; however, racial disparities were observed. Completeness of smoking history documentation, tobacco cessation medication use, and current smoking status were strongly associated with LCS uptake. These findings highlight the need for strategies to improve smoking history documentation and promote tobacco cessation efforts in cancer screening programs and establish the baseline against which the Pink & Pearl program, a co-located breast and lung cancer screening initiative at these sites, will be evaluated.