State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States

Abstract

Background: Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018.

Methods: The American College of Radiology's Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year.

Results: Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation's highest lung cancer mortality rate and one of the highest SRs (13.7%).

Conclusions: Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.

Figure 1.

Proportion of eligible adults aged 55-80 years screened for lung cancer with low-dose computed tomography (LDCT) in the United States, 2016-2018. Lung cancer screening with LDCT in the past year among adults meeting the US preventive services task force (USPSTF) recommendations. USPSTF eligible adults were current or former cigarette smokers who quit within the past 15 years with a 30 or more pack-year smoking history and aged 55-80 years.

Figure 2.

Estimated proportion of adults aged 55-80 years eligible for lung cancer screening with low-dose computed tomography (LDCT) according to US preventive services task force (USPSTF) criteria by state, 2018. USPSTF eligible included adults who are current or former cigarette smokers who quit within the past 15 years with a 30 or more pack-year smoking history and aged 55-80 years.

Figure 3.

Proportion eligible adults aged 55-80 years screened for lung cancer in the past year with low-dose computed tomography (LDCT) by state, 2018. US preventive services task force eligible adults were current or former cigarette smokers who quit within the past 15 years with a 30 or more pack-year smoking history and aged 55-80 years.

Figure 4.

Lung cancer mortality (2013-2017) vs proportion of eligible adults aged 55-80 years screened for lung cancer in the past year with low-dose computed tomography (LDCT) by state, 2018. US preventive services task force eligible adults were current or former cigarette smokers who quit within the past 15 years with a 30 and more pack-year smoking history and aged 55-80 years. Lung cancer mortality was derived from National Program of Cancer Registries data.