Of more than 7 million current and former heavy smokers eligible for screening, only 1.9% underwent screening in 2016, according to an analysis of national screening sites scheduled for presentation at the ASCO Annual Meeting.
“Lung cancer remains the number one cancer killer in America — killing more people than breast, colon, pancreatic and prostate cancers combined annually — with an estimated of 154,040 deaths projected in 2018 alone,” Danh Pham, MD, medical oncologist at the James Graham Brown Cancer Center at University of Louisville, said during a press cast. “In 2011, the National Lung Screening Trial results showed there was a 20% lower risk for dying of lung cancer with a low-dose CT scan.”
Since 2013, the United States Preventive Services Task Force recommended people aged 55 to 80 years who are current or former heavy smokers — defined as at least 30 cigarette pack-years — be screened for lung cancer using low-dose CT. In 2015, CMS expanded Medicare coverage to include lung cancer screening for this population.
Pham and colleagues analyzed screening rates following expanded insurance coverage using data from the 2016 American College of Radiology’s Lung Cancer Screening Registry for 1,796 accredited screening sites. They used 2015 data from the National Health Interview Survey to determine the number of screening-eligible current or former smokers.
Results showed 7,612,975 current and former heavy smokers were eligible nationwide for screening. However, only 1.9% of eligible people (n = 141,260) underwent screening at the accredited sites.
The analysis also included stratification based on the four U.S. census regions in the country: Northeast, South, Midwest and West.
The South had the most screening sites (n = 663) compared with the rest of the U.S., as well as almost 3 million former and current heavy smokers eligible for screening. However, the screening rate was only 1.6%.
The West had the lowest screening rate at 1% compared with 3.5% in the Northeast and 1.9% in the Midwest.
These screening rates are significantly lower compared with other cancer types, Pham said. For example, in 2015, about 65% of women aged 40 years or older had a mammogram.
“This ultimately begs the question on the root of the disparity,” Pham said. “Are physicians not referring patients enough, or are eligible patients not wanting screening, even if they know a test was available? Lung cancer is particularly unique in that there may be a stigma associated with screening, where cancer is attributed to a modifiable risk factor through heavy smoking and the at-risk population may be deterred from wanting screening if diagnosing cancer results in confirming a poor lifestyle choice.”
In order to increase screening rates, Pham recommended making lung cancer screening a national quality health measure, the same way CMS made breast cancer screening and colonoscopy a national area of improvement in 2008.
Primary care physicians generally recommend patients for screening and, therefore, should also be made aware of the screening data, according to Pham. – by Cassie Homer
Pham D, et al. Abstract 6504. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Bristol-Myers Squibb Foundation helped fund this study. Pham reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.