Abstract C120: Evaluating potential disparities in lung cancer screening eligibility and uptake in a large urban healthcare system

Abstract

Abstract Lung cancer screening (LCS) currently has a low reported uptake rate in eligible patients. Identifying the population eligible for screening is crucial to assessing uptake yet is more difficult than for other cancer screening tests as LCS requires documentation of smoking history. Because new screening recommendations may experience disparities in early implementation, it is crucial to evaluate the uptake of LCS in diverse populations. The goal of this study is to evaluate any potential disparities in the uptake of LCS at a large healthcare system in southeast Michigan using previously published eligibility assessment methods. We assessed patient LCS eligibility using Medicare criteria (ages 50-77, currently/formerly smoking within 15 years and at least 20 pack-years) and two methods: a cross-sectional method currently in place clinically and a published algorithm using longitudinal data, accounting for all smoking history entries in the patient’s record. We compared differences in eligibility across patient-reported race and sex groups (Black female, Black male, White female, and White male). Using electronic health record data, we determined how many patients had received an LCS low-dose chest CT (LDCT) or an LDCT for another reason in the previous twelve months. These patients are considered up to date with screening. For both eligibility and uptake, we used Chi-Square for pairwise comparisons with a multiple comparisons adjustment to evaluate differences across race-sex categories. In total, 143,740 patients between the ages of 50-77 with no history of lung cancer had a healthcare encounter between July and December 2022. Of those patients, 38,026 (26.5%) were determined to be eligible for LCS. There were observed differences across the race-sex groups; Black female patients had the lowest proportion of those eligible (20.3%) while White male patients had the highest proportion eligible (29.5%). Of eligible patients, 9,718 (25.6%) received a verified LCS LDCT in the preceding twelve months; 7,144 (18.8%) received a LDCT for another reason; resulting in 44.3% being up to date with screening. Black female patients were the race-sex category with the highest proportion screened in the previous 12 months, and White male patients had the lowest proportion of patients screened (34.0% Black female, 28.8% Black male, 24.5% White female, 24.3% White male; p<0.0001). Black male patients had the highest proportion receiving an LDCT for any reason, and White females had the lowest (51.9% Black female, 52.4% Black male, 41.4% White female, 44.4% White male; p<0.0001). Our estimates indicate that 44.3% of patients would be considered up to date with screening, and 18.8% received an LCS LDCT. These estimates are higher than other reported LCS rates but significantly less than other cancer screening rates. These data do not suggest disparities exist related to the uptake of LCS at our health system; however, uptake remains low and measures to increase uptake should include methods effective and acceptable in diverse patients. Citation Format: Elizabeth R. Alleman, Katie Latack, Jessica Dagenais, Michael Sheehan, Katherine R. Zarins, Vritti Gupta, Michael Simoff, Christine Neslund-Dudas. Evaluating potential disparities in lung cancer screening eligibility and uptake in a large urban healthcare system [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C120.