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. 2025 Mar 3;8(3):e250942.
doi: 10.1001/jamanetworkopen.2025.0942.

Adherence to Annual Lung Cancer Screening and Rates of Cancer Diagnosis

Roger Y Kim  1 , Katharine A Rendle  2 , Nandita Mitra  3 , Christine Neslund-Dudas  4 , Robert T Greenlee  5 , Stacey A Honda  6 , Marilyn M Schapira  7 , Michael J Simoff  8 , Jihyoun Jeon  9 , Rafael Meza  10   11 , Debra P Ritzwoller  12 , Anil Vachani  1
Affiliations

Adherence to Annual Lung Cancer Screening and Rates of Cancer Diagnosis

Roger Y Kim et al. JAMA Netw Open. .

Abstract

Importance: Adherence to annual lung cancer screening (LCS) is a proposed quality metric for LCS programs, but data linking annual adherence to lung cancer outcomes are lacking.

Objective: To investigate annual LCS adherence rates across 2 subsequent LCS rounds among adults undergoing baseline LCS and examine the association of adherence with lung cancer diagnosis rates.

Design, setting, and participants: This retrospective cohort study included adults aged 55 to 75 years who formerly or currently smoked and underwent baseline LCS between January 1, 2015, and December 31, 2018, across 5 US health care systems in the Population-Based Research to Optimize the Screening Process-Lung Consortium. Participants with missing Lung Computed Tomography Screening Reporting & Data System scores or a lung cancer diagnosis prior to LCS initiation were excluded. Data were analyzed from October 2023 to October 2024.

Exposures: For negative baseline screening results, T1 and T2 screening adherence was defined as chest computed tomography (CT) between 10 and 18 months and 22 and 30 months after baseline, respectively. For positive baseline screening results, T1 and T2 adherence was defined as chest CT between 11 and 21 months and 28 and 36 months after baseline, respectively.

Main outcomes and measures: The main outcomes were annual T1 and T2 LCS adherence rates and associations between T1 and T2 screening adherence; annual incident lung cancer diagnoses in rounds T0 (0-12 months after baseline), T1 (>12 to 24 months after baseline), and T2 (>24 to 36 months after baseline); and cancer stage distribution.

Results: A total of 10 170 individuals received baseline LCS (median age, 65 years [IQR, 60-69 years]; 5415 [53.2%] male). During round T1, 6141 of 10 033 eligible patients (61.2% [95% CI, 60.2%-62.2%]) were adherent, and during round T2, 5028 of 9966 eligible patients (50.5% [95% CI, 49.5%-51.4%]) were adherent. T1 adherence was significantly associated with T2 adherence (adjusted relative risk, 2.40; 95% CI, 2.06-2.79). Across 36 months of follow-up, 279 patients (2.7%; 95% CI, 2.4%-3.1%) were diagnosed with lung cancer. Incident lung cancer diagnosis rates were 1.3% (95% CI, 1.1%-1.6%), 0.7% (95% CI, 0.5%-0.8%), and 0.8% (95% CI, 0.6%-0.9%) during rounds T0, T1, and T2, respectively. Lung cancer diagnosis rates were higher among individuals who were LCS adherent vs nonadherent during both rounds T1 (59 of 6141 [1.0%; 95% CI, 0.7%-1.2%] vs 8 of 3892 [0.2%; 95% CI, 0.1%-0.4%]; P < .001) and T2 (63 of 5028 [1.3%; 95% CI, 1.0%-1.6%] vs 12 of 4938 [0.2%; 95% CI, 0.1%-0.4%]; P < .001). A greater proportion of early-stage lung cancers were diagnosed among individuals adherent to screening at T2 compared with those who were not (46 of 63 [73.0%] vs 3 of 12 [25.0%]; P = .006).

Conclusions and relevance: In this multicenter cohort study of adults undergoing LCS, screening adherence was associated with increased overall and early-stage lung cancer detection rates; however, adherence decreased annually after baseline screening, suggesting that it is an important LCS quality metric.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kim reported receiving grants from the National Cancer Institute (NCI) and American Cancer Society, an Early-Stage Investigator Pilot Grant from the Respiratory Health Association, and grants from the University of Pennsylvania’s McCabe Fund during the conduct of the study; having stock in Amgen Inc outside the submitted work; and receiving personal fees from Guidepoint for consulting and from Cambridge Medical Experts for expert testimony outside the submitted work. Dr Rendle reported receiving grants from the National Institutes of Health (NIH) and Gordon and Betty Moore Foundation during the conduct of the study and from AstraZeneca, the National Comprehensive Cancer Network, Pfizer, and the Lung Cancer Research Foundation, paid to the institution, outside the submitted work. Dr Mitra reported receiving grants from the NIH during the conduct of the study. Dr Neslund-Dudas reported receiving grants from the NIH during the conduct of the study. Dr Greenlee reported receiving grants from Kaiser Permanente Colorado and the NCI for this work during the conduct of the study. Dr Honda reported receiving grants from the NCI Population-Based Research to Optimize the Screening Process (PROSPR)–Lung Consortium during the conduct of the study. Dr Schapira reported receiving grants from the University of Pennsylvania Perelman School of Medicine and NCI PROSPR during the conduct of the study. Dr Simoff reported receiving personal fees from Intuitive Surgical for working part time outside the submitted work. Dr Ritzwoller reported receiving grants from the NCI during the conduct of the study and grants and salary support from Pfizer, paid to the institution, outside the submitted work. Dr Vachani reported receiving grants from the NCI during the conduct of the study; receiving personal fees from Johnson & Johnson, Intuitive Surgical, and PreCyte, Inc, outside the submitted work; and receiving grants from Optellum, Ltd, outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Assembly of the Study Cohort and T1 and T2 Adherence Analytic Samples
Among excluded individuals with less than 36 months of health care engagement (n = 1881), 120 (6.4%) were diagnosed with lung cancer and 596 (31.7%) died during the 36-month follow-up period. No individuals in the study cohort died between 0 and 24 months of follow-up after baseline screening. LDCT indicates low-dose computed tomography; Lung-RADS, Lung Computed Tomography Screening Reporting & Data System; PROSPR, Population-Based Research to Optimize the Screening Process; T1, more than 12 months to 24 months after baseline; T2, more than 24 months to 36 months after baseline.
Figure 2.
Figure 2.. Definitions of Longitudinal Annual Lung Cancer Screening Adherence
Round T0 was defined as 0 to 12 months after baseline, round T1 as more than 12 months to 24 months after baseline, and round T2 as more than 24 months to 36 months after baseline. aAmong individuals with negative baseline screening results (Lung Computed Tomography Screening Reporting & Data System [Lung-RADS] score of 1 or 2), T1 and T2 adherence was defined as any repeat computed tomography chest scan within 10 to 18 months and 22 to 30 months after baseline, respectively. bAmong individuals with positive baseline screening results (Lung-RADS score of 3 or 4), T1 and T2 adherence was defined as any repeat computed tomography chest scan within 11 to 21 months and 28 to 36 months after baseline, respectively.
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