Research BriefLung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis
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INTRODUCTION
Lung cancer is the leading cause of cancer-related death in the U.S.1 The National Lung Cancer Screening Trial found that annual low-dose computed tomography (LDCT) screening for lung cancer in high-risk populations resulted in a 20% relative reduction in lung cancer mortality.2 Subsequently, in 2013, the U.S. Preventive Services Task Force began to recommend annual LDCT screening for high-risk populations, current or former smokers (who have quit within the past 15 years) with a 30 pack-year
Study Sample
Data from the Centers for Disease Control and Prevention's 2017 BRFSS survey were used in this analysis. BRFSS is an ongoing, population-based telephone survey conducted across states and participating territories that collects information on health-related risk behavior, chronic disease prevalence, and use of preventive services among the noninstitutionalized adult population.7, 8 Design weights and a raking weighting methodology were used to account for land and cellular phone lines and
RESULTS
The study sample included 4,373 LDCT-eligible survey participants. Among these, 14.4% had a CT scan to check for lung cancer within the past 12 months. Screening among LDCT-eligible individuals varied by sociodemographic characteristic (Table 1). The proportion of individuals who utilized CT screening for lung cancer was higher among insured individuals than among uninsured individuals (15.2% vs 4.0%, p<0.001). Among those with asthma, 22.9% had been screened versus 12.9% of those without
DISCUSSION
These findings describe the CT screening utilization across ten states and among different sociodemographic groups in 2017. Though the 2015 NHIS was representative of the entire U.S. population and utilized different sampling schemes than the 2017 BRFSS, the rate of participation in CT screening in the BRFSS was 10 percentage points higher than previously reported nationally in the 2015 NHIS.6, 7, 11 When the 2015 NHIS survey was being deployed, insurance coverage policies for lung cancer
CONCLUSIONS
Because lung cancer is the leading cause of cancer death in the U.S., there is an impetus to ensure that all individuals at a high risk for lung cancer can access and receive screening. Although rates of lung cancer screening utilization were higher in the 2017 BRFSS than in earlier population-based estimates, utilization of lung cancer screening remains low. Future research should explore why rates of uptake vary by state when insurance coverage for the screening is dictated by federal
ACKNOWLEDGMENTS
No financial disclosures were reported by the authors of this paper.
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