Lung cancer screening limited by poor adherence to follow-up
Patients eligible for lung cancer screening according to U.S. Preventive Services Task Force criteria were more likely to undergo screening if they were older, female, or a current smoker. Less than a quarter of them repeated screening in a year.
Approximately 91% of patients who had lung cancer screening from 2015 to 2019 met U.S. Preventive Services Task Force (USPSTF) criteria, a study found, but adherence to annual follow-up screening was poor, potentially limiting screening effectiveness.
Researchers conducted a cohort study to define sociodemographic characteristics and adherence among persons screened and entered into the American College of Radiology's Lung Cancer Screening Registry (LCSR). Age, sex, and smoking status distributions were compared among patients who were screened and among respondents in the 2015 National Health Interview Survey (NHIS) who were eligible for screening. Adherence to annual screening was defined as having a follow-up test within 11 to 15 months of an initial CT. Results were published Oct. 11 by Annals of Internal Medicine.
Among 1,159,092 persons who were screened, 90.8% (n=1,052,591) met the Task Force eligibility criteria. Compared with adults from the NHIS who met the criteria for screening (n=1,257), those screened as part of the LCSR were older (34.7% vs. 44.8% ages 65 to 74 years; prevalence ratio [PR], 1.29 [95% CI, 1.20 to 1.39]), more likely to be female (41.8% vs. 48.1%; PR, 1.15 [95% CI, 1.08 to 1.23]), and more likely to currently smoke (52.3% vs. 61.4%; PR, 1.17 [95% CI, 1.11 to 1.23]). Only 22.3% of those screened had repeated CT screening in a year. If follow-up was extended to 24 months and more than 24 months, 34.3% and 40.3% were adherent, respectively.
The study authors wrote, “Successful screening programs take time to mature. Colorectal and breast cancer screening have had decades of experience in increasing uptake. The primary care community should leverage this experience to ensure that [lung cancer screening] is delivered to the persons most likely to benefit, and with increased attention to the nearly doubling of the number of eligible persons with the 2021 update of the USPSTF criteria.”
An accompanying editorial noted that clinicians can prevent lung cancer deaths by obtaining a complete smoking history from all patients, particularly men and younger patients eligible for screening, as these groups were underrepresented in the registry, but they must also ensure that patients who are not likely to benefit are not referred for screening. The best way for primary care physicians to prevent lung cancer, the editorialist stressed, is to help patients avoid smoking and to help those who are currently smoking to quit.