Many States Don’t Have Adequate LDCT Screening

A new study has found that more low-dose computed tomography (LDCT) screening centers may be needed in certain geographic areas as the acceptance and practice of LDCT for lung cancer screening continues to grow.

Specifically, Jan M. Eberth, PhD, of University of South Carolina and colleagues, found that several states with a high percentage of people at risk for lung cancer, such as Oklahoma, Nevada, Mississippi and Arkansas, do not have an adequate number of screening centers.

“Organizations such as the American Cancer Society and American College of Radiology recommend that lung cancer screening take place at organized programs with access to multidisciplinary teams and experienced physicians doing a high volume of procedures,” Eberth told Diagnostic Imaging. “There is little information available to date to show exactly where such programs are located. Our study is a first step to identify where low-dose screening programs are located in the United States.” 

Eberth and colleagues studied the geographic locations of 203 LDCT screening centers from the Lung Cancer Alliance Screening Centers or Excellence database, a list of active National Lung Screening Trial and International Early Lung and Cardiac Action Program, and an independent survey of Society of Thoracic Radiology members. Eberth and colleagues compared these locations with rates of lung cancer incidence, mortality, and smoking prevalence. They published their results recently in Lung Cancer.

Nationwide, each state, including Washington DC, had a mean of four screening centers; however, 11 states had no screening centers identified. There was an average of 0.3 screening centers per 100,000 people aged 55 to 79. Among the states with the best capacity of LDCT screening centers were Washington, DC, Connecticut, Virginia, Colorado and Maryland.

“It is expected that the number of screening centers will continue to increase in the coming years, as data show that 90% of centers without an active LDCT screening program are considering adding the service in the near future,” the researchers wrote. “Factors such as the changing status of LDCT screening guidelines and the lack of reimbursement for screening were commonly listed by radiologists as factors that contributed to their institutions’ decision to not offer screening.”

The Northeast and East North Center U.S. were identified as the geographic areas with the most LDCT screening centers. Although they had countries with some of the highest quartiles of lung cancer incidence and mortality, counties in Oklahoma, Louisiana, Mississippi, Arkansas, West Virginia and Missouri had the least screening availability.

One notable exception was Kentucky, where despite a high lung cancer incidence and mortality there was a high screening capacity, “suggesting the positive effect of initiatives such as the Kentucky Cancer Consortium Lung Cancer Prevention and Early Detection Network (funded by the Centers for Disease Control and Prevention),” the researchers wrote.

Data from the study also indicated that those people living in rural areas face greater barriers to screening. “Among these populations, obtaining services is not merely a matter of community to the closest metropolitan area, but may require ‘cross-state’ travel,” the researchers added.

“States with high rates of lung cancer incidence and mortality, smoking, and occupations that predispose workers to lung carcinogens should be particularly concerned with their capacity to screen their high-risk population for lung cancer,” Eberth said. “Policies that ensure the availability and affordability of screening, including mandating reimbursement for screening of high-risk persons, are vital for increasing development of screening programs and their utilization.”