Research Brief
Lung 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. 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.

Section snippets

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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