Introduction
Lung cancer screening reduces mortality in large RCTs where adherence is high. Unfortunately,
recently published adherence rates do not replicate those seen in trials. Previous
publications support a centralized approach to ensure patient eligibility and improve
adherence.
Methods
Investigators reviewed a large, geographically diverse cohort of patients from 14
health systems, with 73 centers across the U.S. Lung cancer screening patients were
screened from 2015 to 2019 and tracked utilizing a commercial system. Data were analyzed
in 2019–2021. Demographics, eligibility, imaging results, and cancer diagnosis were
collected. Overall return was calculated for 2 years (Time 0–Time 1 and Time 1–Time
2) on the basis of follow-up through March 31, 2020. Only U.S. Preventive Services
Task Force–eligible patients with a normal or benign result (Lung-Reporting and Data
System 1 or 2) at baseline (Time 0) were included in annual adherence calculations.
Results
A total of 30,166 patients were screened; 50% were male, with a mean age of 65 years.
Most individuals currently smoked (58.3%), with an average of 48.3 pack years. A total
of 58% were White, 6% were Black, and 34% had race information unavailable. U.S. Preventive
Services Task Force eligibility criteria were not met by 10.6%. Of the 26,958 patients
eligible at baseline, 76% were Lung-Reporting and Data System 1 or 2. Annual adherence
at Year 1 (Time 0–Time 1) was 48.4%. Adherence at Year 2 (Time 1–Time 2) was 44.4%.
A total of 93 U.S. Preventive Services Task Force‒eligible patients were diagnosed
with lung cancers, mostly during the first annual follow-up.
Conclusions
In this large cohort screened and managed primarily using a commercial tracking platform,
most patients were U.S. Preventive Services Task Force eligible. However, annual adherence
was poor despite this resource, suggesting that additional interventions are needed
to recognize the full mortality benefit from screening programs.
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Article Info
Publication History
Published online: March 29, 2022
Identification
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
