Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

Abstract

Importance: Currently, computed tomography (CT) is used for lung cancer screening (LCS) among populations with various levels of compliance to the eligibility criteria from the US Preventive Services Task Force (USPSTF) recommendations and may represent suboptimal allocation of health care resources.

Objective: To evaluate the appropriateness of CT LCS according to the USPSTF eligibility criteria.

Design, setting, and participants: This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants included individuals who responded to the LCS module administered in 20 states and had valid answers to questions regarding screening and smoking history. Data were analyzed between October 2021 and August 2022.

Exposures: Screening eligibility groups were categorized according to the USPSTF 2013 recommendations, and subgroups of individuals who underwent LCS were analyzed.

Main outcomes and measures: Main outcomes included LCS among the screening-eligible population and the proportions of the screened populations according to compliance categories established from the USPSTF 2013 and 2021 recommendations. In addition, the association between respondents' characteristics and LCS was evaluated for the subgroup who were screened despite not meeting any of the 3 USPSTF screening criteria: age, pack-year, and years since quitting smoking.

Results: A total of 96 097 respondents were identified for the full study cohort, and 2 subgroups were constructed: (1) 3374 respondents who reported having a CT or computerized axial tomography to check for lung cancer and (2) 33 809 respondents who did not meet any screening eligibility criteria. The proportion of participants who were under 50 years old was 53.1%; between 50 and 54, 9.1%; between 55 and 79, 33.8%; and over 80, 4.0%. A total of 51 536 (50.9%) of the participants were female. According to the USPSTF 2013 recommendation, 807 (12.8%) of the screening-eligible population underwent LCS. Among those who were screened, only 807 (20.9%) met all 3 screening eligibility criteria, whereas 538 (20.1%) failed to meet any criteria. Among respondents in subgroup 2, being of older age and having a history of stroke, chronic obstructive pulmonary disease, kidney disease, or diabetes were associated with higher likelihood of LCS.

Conclusions and relevance: In this cross-sectional study of the BRFSS 2019 survey, the low uptake rate among screening-eligible patients undermined the goal of LCS of early detection. Suboptimal screening patterns could increase health system costs and add financial stress, psychological burden, and physical harms to low-risk patients, while failing to provide high-quality preventive services to individuals at high risk of lung cancer.

Figure 1.. Ascertainment of Study Cohorts

Screening eligibility criteria were based on the 2013 US Preventive Services Task Force (USPSTF) lung cancer screening recommendations. BRFSS indicates Behavioral Risk Factor Surveillance System; CT, computerized tomography; CAT, computerized axial tomography; LCS, lung cancer screening.

Figure 2.. Weighted Proportion of Different Screening Compliance Groups per 2013 and 2021 US Preventive Services Task Force (USPSTF) Recommendations Among CT Screened Population

Figure 3.. Odds Ratios (ORs) for CT Screening for Lung Cancer Among the Population Who Did Not Fulfill Any Eligibility Criteria in From the 2013 US Preventive Services Task Force Recommendation

COPD indicates chronic obstructive pulmonary disease.