Study Finds Low Use of LDCT Among Eligible Candidates for Lung Cancer Screening

Despite the reported screening benefits of low-dose computed tomography (LDCT) in reducing lung cancer mortality rates, LDCT remains significantly underutilized, according to an analysis of insurance claims data from over 1,077,000 people eligible for lung cancer screening.^1,2

In the retrospective study, recently published in the Journal of the American College of Radiology, researchers reviewed 2017 insurance claims data for 1,077,142 people eligible for lung cancer screening and compared lung cancer screening rates among people with commercial health-care insurance, participants in Medicare fee-for-service plans and those enrolled with Medicare Advantage carriers.

The study authors found that 4.56 percent of Medicare Advantage enrollees had LDCT lung cancer screening in 2017. The LDCT screening rates for Medicare fee-for-service enrollees and those on commercial insurance were 3.37 percent and 1.75 percent respectively, according to the study.²

While the researchers noted that the Affordable Care Act requires most insurers to cover lung cancer screening for people who meet the screening eligibility requirements of the United States Preventive Services Taskforce (USPSTF), they found significant racial and geographic disparities with lung cancer screening among the insured study cohort.

In comparison to a 3.71 percent screening rate for non-Hispanic Whites, the researchers noted 2.17 and 1.68 screening rates for non-Hispanic Blacks and other races respectively.² Pointing out that a reported lower intensity of smoking in the non-Hispanic Black population may have reduced their eligibility for lung screening with the 2013 USPSTF criteria, the study authors suggested the expansion of LDCT eligibility, which reduced the age (50 years of age) and pack-year smoking history thresholds (20 pack years), will be beneficial in this population. They also emphasized the need for better awareness of the availability of LDCT screening.^3,4

“A primary cause for non-Hispanic Black enrollees to be unscreened for lung cancer is lack of awareness of lung cancer screening programs, and our results thus highlight another opportunity for educating non-White patients and better engaging their providers,” wrote study co-author Robert A. Smith, Ph.D., a senior vice president of Early Cancer Detection Science with the American Cancer Society, and colleagues.

(Editor’s note: For related content, see “Nine Takeaways from Recent Meta-Analysis on Lung Cancer Screening with Low-Dose CT,” “Can Ultra-Low-Dose CT be Effective for Lung Cancer Screening in Current or Past Smokers?” and “New Computed Tomography Study Shows High 20-Year Survival Rates for Early-Stage Lung Cancer.”)

The study authors also noted significantly higher LDCT screening rates in the Northeast and significantly lower LDCT rates in rural areas in comparison to urban areas. Smith and colleagues emphasized the need for expanded access to LDCT screening facilities and future research that examines the impact of socioeconomic determinants upon lung cancer screening.

“Despite having larger eligible populations due to higher smoking rates, enrollees residing in rural areas face greater barriers to access than urban enrollees because of factors such as lack of a referral from a health care provider, inadequate transportation, greater average distances to the closest (lung cancer screening) facility, and lower rates of insurance,” said Smith and colleagues.

In regard to study limitations, the authors noted their findings from databases of people with commercial or Medicare insurance may not be applicable for uninsured populations or those on Medicaid. The researchers acknowledged potential bias as self-reported smoking data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS), which they relied upon for lung cancer screening eligibility estimates, does not address smoking history duration.

References

1. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409.

2. Hughes DR, Chen J, Wallace AE, Duszak Jr R, Rula EY, Smith RA. Comparison of lung cancer screening eligibility and use between commercial, Medicare, and Medicare Advantage enrollees. J Amer Coll Radiol. 2023;20(4):402-410.

3. Haddad DN, Sandler KL, Henderson LM, Rivera MP, Aldrich MC. Disparities in lung cancer screening: a review. Ann Am Thorac Soc. 2020;17(4):399-405.

4. Hall J. CMS expands Medicare eligibility for CT lung cancer screening. Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/cms-expands-medicare-eligibility-for-ct-lung-cancer-screening . Published February 15, 2022. Accessed March 30, 2023.