Jul 2026· Journal of the American College of Radiology· 0 citations· 51 references
Medicine
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.
Lung cancer screening using low-dose computed tomography (LDCT) is recommended for high-risk individuals, yet uptake remains low. We evaluated screening eligibility and completion among adults with lung cancer. In the 2024 National Health Interview Survey, adults aged ≥ 50 years with a lung cancer diagnosis within the past 10 years were included. Eligibility at diagnosis was determined using 2021 United States Preventive Services Task Force criteria based on self-reported smoking history. LDCT completion before diagnosis was assessed. Weighted multivariable logistic regression identified factors associated with outcomes. 115 participants were included (weighted n = 638,702). Eligibility could not be determined for 3.5% (4/115). Among those with known eligibility, 52.3% (58/11) met screening criteria at diagnosis. Female sex (OR 0.31; 95% CI 0.12–0.77; p = 0.01) was associated with lower odds of eligibility, while non-white race showed a trend toward lower eligibility (OR 0.35; 95% CI 0.12–1.04; p = 0.06). After excluding participants who never smoked, no variables were significant. Overall, 83.6% (92/110) reported receipt of LDCT, but only 32.7% (36/110) received it before diagnosis. No variables were significantly associated with screening completion. Among US adults with lung cancer, approximately half were screening-eligible, and only one-third underwent screening before diagnosis, highlighting gaps in both eligibility and utilization.
Izabella Zanazanian, Angela Y Chieh, Aarushi Madan et al.· Cancer Causes and Control· 0 citations
Individuals with rheumatoid arthritis (RA), particularly those with a history of smoking, are at increased risk for lung cancer. However, real-world data on the use of low dose computed tomography (LDCT) screening for lung cancer in this population are lacking. Therefore, we assessed the rates, trends, and predictors of LDCT screening among patients with a smoking history and RA. A retrospective cohort study using the IQVIA PharMetrics® Plus for Academics Closed Health Plan claims database was conducted. Patients with RA diagnosed in 2014-2023, aged 50-77 years, and with a history of smoking and no prior cancer or advanced respiratory illness were identified. LDCT screening was identified using Healthcare Common Procedure Coding System codes. Among 15,341 eligible patients, 997 (6.5%) received LDCT screening; median time from RA diagnosis to first LDCT claim was 452 days. In a sensitivity analysis of 12,301 patients with continuous insurance coverage during the 12 months after RA diagnosis, only 367 (3%) underwent LDCT within the first year after RA diagnosis. Demographic factors such as male sex (aOR=1.24; p=0.003), age 55-69 (aOR=~1.90; p<0.0001), and residence outside the West region (p<0.0001) increased uptake. Clinical characteristics and healthcare utilization such as COPD (aOR=2.85; p<0.0001), more outpatient visits (aOR=2.15-2.41; p< 0.001) and DMARD use (aOR=1.27-1.52; p≤ 0.001) also increased odds, whereas greater comorbidity burden reduced screening (aOR=0.79-0.39; p≤0.006). In conclusion, LDCT rates in patients with RA remained low overall and varied according to demographic and clinical factors. Targeted efforts may be needed to improve screening uptake in this high-risk population.
M. Lopez-Olivo, Zhi-Gang Duan, Huifang Lu et al.· Cancer Prevention Research· 0 citations
BACKGROUND
Lung cancer screening (LCS) rates are low despite expanded eligibility criteria. Many patients receiving cardiac CT scans may also have risk factors for lung cancer. We aimed to identify an opportunity to increase LCS by quantifying this population.
METHODS
All patients in our healthcare system from January 2011 to December 2023 who received a CT heart or CT angiogram heart were included. Lung cancer rates in this population were assessed. LCS eligibility was determined by USPSTF guidelines.
RESULTS
A total of 31,684 patients received cardiac CT scans and 17,232 patients met the study criteria (documented smoking history, age 50-80 years, no prior diagnosis of lung cancer). Based on 2021 USPSTF guidelines, 114 (0.7%) patients were eligible for LCS compared to 0.37% of all patients in our healthcare system. A total of 73 patients undergoing cardiac CT developed a diagnosis of lung cancer. Among those meeting LCS eligibility, 1 (0.8%) developed lung cancer, 7 (6.1%) received a low dose CT, and 21 (18.4%) received a diagnostic chest CT. An additional 72 (0.4%) patients of patients who received a cardiac CT were subsequently diagnosed with lung cancer at a median of 19.8 (5.7, 51.7) months, yet did not meet LCS eligibility.
CONCLUSIONS
Risk of lung cancer diagnosis among patients receiving cardiac CT scan is significantly higher than that of the general population. However, most of these patients did not qualify for LCS. Advocacy for more complete chest imaging in this population may facilitate identification of lung cancer for early intervention.
Lillian L. Tsai, Chinasa Anokwuru, N. Kapula et al.· Annals of Thoracic Surgery· 0 citations
BACKGROUND
Current US Preventive Services Task Force lung cancer screening criteria exclude an estimated 40%-70% of individuals who ultimately develop lung cancer. Coronary calcium screening CT routinely captures thoracic anatomy and may provide an opportunity for earlier lung cancer detection outside established screening pathways.
STUDY DESIGN
Retrospective cohort study of 9,702 adults undergoing coronary calcium screening CT at five hospitals within a single health system (2019-2022), excluding patients meeting 2021 U.S. Preventive Services Task Force screening criteria. Pulmonary findings were classified using 2017 Fleischner Society guidelines with longitudinal follow-up. Outcomes included pulmonary nodule detection, follow-up adherence, lung cancer diagnosis, stage at diagnosis, and modeled mortality, cost-effectiveness, radiation-associated harm, and unnecessary interventions.
RESULTS
Actionable pulmonary nodules were identified in 1,136 patients (11.7%), of whom 486 (42.8%) completed recommended follow-up. Lung cancer was confirmed in 18 patients (3.7% of those completing follow-up); 83.3% had stage I disease, all of whom underwent curative resection, with 100% overall survival after a mean follow-up of 49.5 months. Modeled implementation of full field-of-view reconstruction with universal follow-up was estimated to avert 339 deaths (95% uncertainty interval, 190-417) per 100,000 screened at an incremental cost of $5,856 per quality-adjusted life-year, with benefit-to-risk ratios exceeding 100:1. Histology-specific growth modeling suggested that 75% of cancers in the Non-Guideline Institutional cohort would have been detectable at least 12 months before diagnosis.
CONCLUSIONS
Systematic assessment of thoracic structures already imaged during coronary calcium screening CT, combined with reliable guideline-concordant pulmonary nodule follow-up, may complement existing lung cancer screening by enabling earlier detection among patients outside current screening eligibility.
Austin Drysch, Alexandra Abbott, Trevor Barnum et al.· Journal of the American Coll...· 0 citations
Survivors of head and neck cancer are at elevated risk for secondary primary lung cancer, independent of smoking history, yet LDCT screening in this population is both likely underutilized and inconsistently captured in national survey data, in part because the smoking-history elements needed to determine eligibility are often missing. We used nationally representative 2022 Behavioral Risk Factor Surveillance System data to examine lung cancer screening prevalence among head and neck cancer survivors and screening patterns by eligibility under 2013 and 2021 US Preventive Services Task Force criteria. More than one-third of survivors lacked sufficient information on smoking history to assess eligibility. Screening was highest among survivors meeting 2013 criteria (64%) compared with those eligible under 2021 criteria (40%) and those ineligible under either criterion (32%). The 2021 criteria expansion increased the number of survivors eligible for screening but did not translate into a proportional increase in CT scanning rates. These findings suggest that eligibility expansion alone may be insufficient without systematic collection of smoking history and streamlined referral pathways.
Anna R. Zhao, J. Cramer· Otolaryngology Head & Neck S...· 0 citations
Interventions addressing primary care attachment and upstream social determinants may improve early detection and access to curative therapy in lung cancer stage at diagnosis and surgical treatment persist in Ontario.
N. Hanna, Saad Shakeel, G. Akhtar-Danesh et al.· PLoS ONE· 0 citations
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