Abstract
This study examines the use of preventive lung, breast, and colorectal cancer screening among eligible and ineligible US adults.
Lung cancer screening (LCS) for adults with a smoking history has been recommended by the US Preventive Services Task Force (USPSTF) since 2013 and could potentially save tens of thousands of lives annually.1 However, adoption rates remain low, with only 18% of eligible individuals undergoing screening in 2022.2 Tobacco use is more common in adults of low socioeconomic status and with mental illness,3 leading some to believe that individuals eligible for LCS may be less receptive to cancer screening.4
Use of other preventive services among adults eligible for LCS may provide insight into their accessibility for outreach. This study evaluated use of other cancer screening tests among US adults eligible for LCS and ineligible for LCS.
Methods
Participants aged 50 to 79 years in the 2022 US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) dataset were grouped according to whether they met the 2021 USPSTF criteria for LCS (eAppendix in Supplement 1). LCS-eligible participants were classified by whether they met the (1) 2016 USPSTF criteria for breast cancer screening (BCS) (LCS/BCS dual eligibility cohort) or (2) 2021 USPSTF criteria for colorectal cancer screening (CCS) (LCS/CCS dual eligibility cohort) (eAppendix in Supplement 1). Within each of the dual eligibility cohorts, we compared the proportion of individuals who underwent each of the screening tests for which they qualified (eAppendix in Supplement 1). We also evaluated use of BCS and CCS among all BRFSS participants eligible for each test, comparing those who were eligible for LCS vs ineligible for LCS.
BRFSS survey weights were applied to obtain national estimates of the use of each preventive health care service. The Mass General Brigham Institutional Review Board deemed this study exempt from review since only deidentified publicly available data were analyzed.
Results
Among 212 393 BRFSS participants aged 50 to 79 years who met the study inclusion criteria, 28 483 (weighted population, 13 168 937) were eligible for LCS.
A total of 11 147 BRFSS participants (weighted population, 4 945 993) were included in the LCS/BCS dual eligibility cohort and 24 172 (weighted population, 11 232 624) were included in the LCS/CCS dual eligibility cohort. In the LCS/BCS dual eligibility cohort, 7248 participants underwent BCS (weighted estimate, 65.0% [95% CI, 63.1%-66.8%]); in contrast, 2000 (17.0% [95% CI, 15.6%-18.3%]) underwent LCS (Figure, A). In the LCS/CCS dual eligibility cohort, 15 864 (64.7% [95% CI, 63.4%-65.9%]) participants underwent CCS, whereas 4492 (17.5% [95% CI, 16.6%-18.5%]) underwent LCS. In a subgroup analysis of LCS-eligible participants who had never undergone LCS, 4738 (60.2% [95% CI, 58.0%-62.3%]) underwent BCS and 9888 (58.7% [95% CI, 57.2%-60.2%]) underwent CCS. Analyses stratified by sociodemographic factors found that receipt of CCS and BCS was at least 3 times higher than receipt of LCS in nearly all subgroups (Table).
Figure. Use of Preventive Health Care Among US Adults Eligible for Lung Cancer Screening (LCS) and Ineligible for LCS.
A, Individuals dually eligible for LCS and BCS included those eligible for LCS who also met the 2016 USPSTF BCS criteria (ie, females aged 50-74 years). Individuals dually eligible for LCS and CCS included those eligible for LCS who also met the 2021 USPSTF CCS criteria (ie, individuals aged 50-75 years). B, Use of BCS was evaluated only among individuals who also met the 2016 USPSTF BCS criteria and use of CCS was only evaluated among individuals who also met the 2021 USPSTF CCS criteria. Information regarding how preventive health care services were defined is included in the eAppendix in Supplement 1. Whiskers on the bars indicate 95% CIs.
BCS indicates breast cancer screening; CCS, colorectal cancer screening; USPSTF, US Preventive Services Task Force.
Table. Use of Preventive Health Care Services Among US Adults Eligible for Lung Cancer Screening (LCS) Stratified by Sociodemographic Factors.
| Individuals eligible for LCS, No. | ||||||
|---|---|---|---|---|---|---|
| LCS/BCS dual eligibility cohorta | LCS/CCS dual eligibility cohorta | |||||
| Unweighted | 12 371 | 26 631 | ||||
| With complete cancer screening data, unweightedb | 11 147 | 24 172 | ||||
| With complete cancer screening data who underwent LCS, unweighted | 2000 | 4492 | ||||
| With complete cancer screening data, weighted | 4 945 993 | 11 232 624 | ||||
| With complete cancer screening data who underwent LCS, weighted | 838 187 | 1 965 448 | ||||
| LCS use, weighted % (95% CI)c | 17.0 (15.6-18.3) | 17.5 (16.6-18.5) | ||||
| Characteristic | Sample, No. (%) | LCS use, weighted % (95% CI) | BCS use, weighted % (95% CI) | Sample, No. (%) | LCS use, weighted % (95% CI) | CCS use, weighted % (95% CI) |
| Age, y | ||||||
| 50-59 | 3800 (34.1) | 9.6 (8.3-11.1) | 58.4 (55.3-61.4) | 8086 (33.5) | 10.0 (8.9-11.2) | 54.1 (52.1-56.1) |
| 60-69 | 5428 (48.7) | 21.1 (18.9-23.4) | 69.6 (67.1-71.9) | 11 271 (46.6) | 20.4 (19.0-21.9) | 70.3 (68.5-72.0) |
| 70-75d | 1919 (17.2) | 21.9 (18.2-26.1) | 66.6 (61.0-71.7) | 4815 (19.9) | 26.5 (23.8-29.3) | 72.9 (69.9-75.8) |
| Household income, $ | ||||||
| <25 000 | 3125 (28.0) | 17.6 (15.3-20.1) | 59.0 (55.0-62.8) | 6232 (25.8) | 18.7 (16.9-20.7) | 59.1 (56.5-61.7) |
| 25 000-74 999 | 4530 (40.6) | 18.3 (16.2-20.6) | 65.4 (62.7-68.1) | 9744 (40.3) | 18.2 (16.9-19.7) | 66.0 (64.2-67.8) |
| ≥75 000 | 1907 (17.1) | 14.1 (11.0-17.9) | 73.1 (69.1-76.7) | 4979 (20.6) | 15.9 (13.8-18.3) | 70.5 (67.9-72.9) |
| Unknown | 1585 (14.2) | 16.1 (13.0-19.8) | 64.4 (59.7-68.8) | 3217 (13.3) | 16.0 (13.9-18.3) | 61.8 (58.6-65.0) |
| Education | ||||||
| Less than high school | 973 (8.7) | 12.8 (10.3-15.9) | 54.4 (47.7-60.9) | 2427 (10.0) | 15.4 (13.4-17.6) | 53.0 (49.3-56.6) |
| High school or general educational development | 3786 (34.0) | 19.1 (16.8-21.6) | 64.0 (61.1-66.8) | 8676 (35.9) | 17.7 (16.2-19.3) | 62.7 (60.6-64.6) |
| Some college | 4050 (36.3) | 17.1 (14.9-19.5) | 69.2 (66.5-71.7) | 8157 (33.8) | 18.4 (16.8-20.1) | 70.4 (68.6-72.2) |
| College graduate or more | 2319 (20.8) | 16.1 (13.3-19.3) | 68.7 (64.9-72.2) | 4854 (20.1) | 17.2 (14.9-19.8) | 71.3 (68.3-74.0) |
| Unknown | 19 (0.2) | 9.4 (2.6-28.6) | 17.8 (6.4-40.5) | 58 (0.2) | 21.8 (10.6-39.6) | 37.2 (22.1-55.3) |
| Usual source of health caree | ||||||
| No | 815 (7.3) | 3.9 (2.2-6.8) | 22.9 (17.6-29.1) | 2424 (10.0) | 4.3 (3.1-6.2) | 29.7 (26.2-33.4) |
| Yes | 10 285 (92.3) | 18.1 (16.7-19.6) | 68.5 (66.7-70.3) | 21 596 (89.3) | 19.1 (18.1-20.2) | 69.0 (67.7-70.3) |
| Unknown | 47 (0.4) | 1.2 (0.3-4.0) | 54.3 (32.9-74.2) | 152 (0.6) | 11.1 (5.7-20.4) | 47.8 (35.6-60.2) |
| Insurance status | ||||||
| Private | 3391 (30.4) | 15.3 (13.0-18.0) | 68.0 (65.1-70.8) | 7299 (30.2) | 14.3 (12.8-16.0) | 65.7 (63.7-67.6) |
| Medicare | 4719 (42.3) | 21.4 (19.1-23.8) | 67.5 (64.2-70.7) | 9758 (40.4) | 23.1 (21.4-24.8) | 72.2 (70.2-74.1) |
| Medicaid | 1192 (10.7) | 15.1 (12.2-18.5) | 63.7 (58.2-68.8) | 2223 (9.2) | 15.9 (13.4-18.8) | 55.5 (51.5-59.5) |
| Otherf | 1001 (9.0) | 12.9 (9.9-16.7) | 71.2 (65.9-76.0) | 2956 (12.2) | 17.6 (15.3-20.3) | 66.9 (62.7-70.8) |
| Uninsured | 519 (4.7) | 3.1 (1.6-5.9) | 22.6 (16.5-30.2) | 1227 (5.1) | 3.7 (2.4-5.6) | 26.0 (21.8-30.7) |
| Unknown | 325 (2.9) | 19.6 (12.2-30.0) | 57.0 (46.0-67.3) | 709 (2.9) | 16.2 (11.9-21.6) | 58.0 (51.2-64.4) |
| Rural vs urban | ||||||
| Urban | 9116 (81.8) | 17.1 (15.7-18.7) | 65.4 (63.4-67.3) | 19 644 (81.3) | 17.6 (16.6-18.7) | 65.2 (63.9-66.5) |
| Rural | 1906 (17.1) | 15.9 (13.2-19.1) | 61.0 (56.5-65.4) | 4182 (17.3) | 17.0 (14.9-19.2) | 61.1 (57.9-64.1) |
| Unknown | 125 (1.1) | 8.0 (3.9-15.8) | 69.1 (53.1-81.6) | 346 (1.4) | 9.8 (5.7-16.4) | 50.6 (41.1-60.0) |
Abbreviations: BCS, breast cancer screening; CCS, colorectal cancer screening; USPSTF, US Preventive Services Task Force.
LCS/BCS cohort included those eligible for LCS who also met 2016 USPSTF BCS criteria; LCS/CCS, those eligible for LCS who also met 2021 USPSTF CCS criteria.
Use of each test evaluated among individuals with complete screening use data. In LCS/BCS cohort, individuals with data for use of LCS and BCS were included; LCS/CCS, individuals with complete data for use of LCS and CCS.
Weighted percentage use of each test by cohort calculated by dividing weighted No. of individuals who underwent test by total weighted No. of individuals in cohort with complete screening use data.
In LCS/BCS cohort, age range was 50-74 years (no individuals were aged 75 years); LCS/CCS, 50-75 years.
Having 1 person or a group of physicians an individual considered to be their personal health care provider(s).
Included military-related health insurance, Indian Health Service, state-sponsored health plans, and other government programs.
The use of both BCS and CCS was lower among participants eligible for LCS than among those ineligible for LCS (Figure, B).
Discussion
In this US national analysis, use of BCS and CCS among individuals eligible for LCS was nearly 4-fold higher than use of LCS. Even among LCS-eligible persons who had never undergone LCS, 59% to 60% had undergone other cancer screening tests.
These findings suggest that many people eligible for LCS are accessible to outreach and receptive to receiving preventive health care services. The results highlight the need for interventions to increase awareness about LCS and to reduce barriers—including difficulties assessing LCS eligibility (due to the use of age and multiple smoking history requirements) and challenges accessing LCS clinics5—that prevent individuals from undergoing screening. The potential for improvement is underscored by a 2024 study that found that an electronic health record–integrated intervention substantially increased LCS rates in 1 health care system.6
This study’s finding that BCS and CCS use was slightly lower among LCS-eligible persons compared with LCS-ineligible persons may reflect a greater burden of barriers to accessing preventive health care in the LCS-eligible population, further highlighting the need for interventions.
Limitations of the current study include the use of self-reported data on preventive health care use, which may be subject to measurement bias, and a lack of information on what barriers may have hindered screening.
Supplementary Information and eFigures
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
Supplementary Information and eFigures
Data Sharing Statement
