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. 2022 Mar;19(3):480-487.
doi: 10.1016/j.jacr.2021.12.003. Epub 2022 Feb 7.

Implementation and Uptake of Rural Lung Cancer Screening

Tri Le  1 , Stacie Miller  2 , Emily Berry  3 , Sarah Zamarripa  4 , Aurelio Rodriguez  5 , Benjamin Barkley  6 , Asha Kandathil  7 , Cecelia Brewington  8 , Keith E Argenbright  9 , David E Gerber  10
Affiliations

Implementation and Uptake of Rural Lung Cancer Screening

Tri Le et al. J Am Coll Radiol. 2022 Mar.

Abstract

Objective: Given the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence.

Methods: In collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion.

Results: To raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430.

Discussion: Implementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.

Keywords: CT; Community; navigation; stakeholder; tobacco.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Lung Cancer Screening Algorithm 1Interval scan to evaluate indeterminate CT scan at interval < 12 months until there is resolution or findings. 2Go to PET-CT and/or subsequent biopsy to occur within weeks of screening result.
Figure 2.
Figure 2.
Patients referred to, eligible for, and completing low-dose computed tomography (LDCT)-based lung cancer screening.
See this image and copyright information in PMC

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