Digital Outreach as a Lever to Improve Lung Cancer Screening Rates.

Background:The participation rate is one of the most important indexes in the cancer screening. Historically in Japan, each local government has developed their own equations to calculate the subjects for population-based screening, which were different from each other, and therefore the participation rates of screening were not comparable. Recently, local governments were ordered to use the standardized equation in reporting data, which made it possible to compare the participation rates of cancer screening nationwide for the first time. We therefore investigated the correlation between the prefectural lung cancer mortality and several indicators of lung cancer screening.Methods:The prefectural participation rates of lung, gastric and colonic cancer screening, test positive rates, attendance rates for further examination, lung cancer detection rates and positive predictive values of lung cancer screening were collected from “Cancer Registration and Statistics” of the National Cancer Research Center website. The age-adjusted lung, gastric and colonic cancer mortality rates, smoking rates were also collected. The EZR software program was used for statistical analyses.Results:The participation rates of lung cancer screening had a strong positive correlation with the participation rates of gastric/colonic cancer screening (P<0.001). The prefectural lung cancer mortality rates had a moderate to weak negative correlation with the participation rates of lung cancer screening (P=0.009). A little correlation was noted between other quality assurance indicators of lung cancer screening and lung cancer mortality rates.Conclusion:These results suggested that participating in lung cancer screening might help reduce lung cancer mortality rates in some extent.

e23231 Background: Lung Cancer is by far the leading cause of cancer death, making up almost 25% of all cancer deaths. Shockingly, each year more people die of lung cancer than colon, breast, and prostate cancers combined. Due to the late diagnosis, usually in the metastatic phase, the mortality is poor with more than half of patients dying within one year of diagnosis. Texas is 43rd in the nation in diagnosing lung cancer at an early stage. On a national level, approximately 5.8% of patients at high risk for lung cancer are screened, while in Texas, only 1.8% of all high-risk patients undergo screening. Furthermore, in East Texas, the rates of smoking and lung cancer are the highest in the entire state of Texas. In this quality improvement project, we sought to improve rates of lung cancer screening by raising awareness about the significance of lung cancer, addressing knowledge gaps about lung cancer screening guidelines, and educating physicians about how to have these life-saving conversations with patients. Methods: A retrospective analysis was performed from the quarterly CHRISTUS Good Shepherd Internal Medicine Resident Clinic lung cancer screening metrics using our EPIC electronic medical records from September 2022 to February 2024. The lung cancer screening metric reflects the calculated the percentage of patients age 50-77 who are on the smoking risk history registry who have had a lung cancer screening exam within the last year. Our intervention consisted of multiple sessions of in person and virtual lectures, educating residents about how to calculate and document smoking pack years, counsel patients on the importance of lung cancer screening, and order lung cancer screening using the EPIC order set. Results: Prior to any interventions, CHRISTUS Good Shepherd Internal Medicine Resident Clinic lung cancer screening metric was at 42% during the 3rd quarter of 2022. In-class lectures started during the 4th quarter of 2022. At the 4th quarter of 2022 and the 1st quarter of 2023, lung cancer screening rates increased to 44% and 52%, respectively. It was noticed that the metric plateau was about 48% over the next two quarters resulting in an overall increase of 5% from the pre-intervention phase. Conclusions: Our project showed that educating residents on the lung cancer screening guidelines and its application in clinical practice led to an increased rate of lung cancer screenings. The plateau in our study highlights the need for ongoing medical education and additional interventions to achieve substantial improvements in screening rates. Perhaps, targeting education toward patients about the importance, affordability, and safety of lung cancer screening could complement resident education and create a synergistic effect. We aim to further investigate how patient-centered interventions, like providing educational flyers in clinics and public places, can influence lung cancer screening rates.

BackgroundLung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system where LCS is a member benefit. The California LCS rate is 0.7%.MethodsThis cohort study analyzed KPNC 2015-2022 electronic health records. Lung cancer screening rates were compared among AsA subgroups, controlling for sociodemographics, considering both more restrictive 2013 (n = 2,273) and more inclusive 2021 (n = 5,823) United States Preventive Services Task Force (USPSTF) LCS guidelines, which differ by age range and years post-smoking cessation.ResultsOverall KPNC LCS rates for eligible AsA patients were 4.3% and 2.7% using USPSTF 2013 and 2021 guidelines, respectively. Lung cancer screening rates varied by AsA subgroup. Under 2021 guidelines, Chinese (4.0%) were screened more than Korean (3.57%), Southeast Asian (3.52%), Japanese (3.19%), Asian (Other) (2.28%), Pacific Islander (1.91%), and Filipino (1.55%). Under 2013 guidelines, Southeast Asian (6.54%) were screened more than Chinese (6.51%), Japanese (5.36%), Asian (Other) (3.95%), and Filipino (1.93%).DiscussionThis is the first study to demonstrate significant heterogeneity in LCS rates for disaggregated AsA subgroups. Kaiser Permanente Northern California LCS rates were 4× California rates. When payment alone is not a care barrier, systemic and culturally sensitive interventions are necessary to increase overall LCS screening rates and address population-specific disparities.

Introduction: Lung cancer is a leading cause of cancer deaths worldwide. Despite advances in cancer care, the low five-year survival rate for lung cancer is due to late-stage diagnoses. Early detection through lung cancer screening is vital for improving patient outcomes. However, racial disparities persist, with Black individuals experiencing higher rates and advanced stages of the disease. This retrospective study assessed racial and gender disparities in lung cancer screening rates among different racial groups at WakeMed Health and Hospital outpatient primary care clinics. Study design: The study utilized data from the lung cancer screening registry, focusing on the period between Jan 1st 2017 and May 15th 2023. The data was obtained from the EPIC electronic medical record system and exported to Excel. We implemented filters to narrow down the patient population that met the U.S. Preventive Services Task Force inclusion criteria for lung cancer screening. Eligible patients for lung cancer screening are those aged 50 to 80 years, either current smokers or individuals who quit smoking within the past 15 years and have a smoking history of at least 20 pack years. The study focused on three racial groups: Asian, Black, and White populations. Results: Among the 2,098 patients who met the inclusion criteria, 15.5% were Black (n=326), 0.01% were Asian (n=23), and 83.4% were White (n=1,749). The screening rates for lung cancer were calculated for each racial group. The Asian population had a screening rate of 26% (6 out of 23 patients), the Black population had a rate of 32% (103 out of 326 patients), and the White population had a rate of 31% (543 out of 1,749 patients). Among the Asian population, the screening rate for Asian males was 20% (4 out of 20 patients), while for Asian females, it was relatively higher at 67% (2 out of 3 patients). For the Black male population, the screening rate was 31% (52 out of 167 patients), while among females, it was 32% (51 out of 159 patients). Among the White population, white males were screened at a rate of 33% (313 out of 962 patients), while among females, it was slightly lower at 29% (230 out of 787 patients). Conclusion: The findings reveal no significant difference in lung cancer screening rates between racial groups or genders. Caution must be exercised when interpreting the findings for the Asian population due to the small sample size. Further research using a larger and more diverse dataset is necessary to draw more robust conclusions regarding potential disparities in lung cancer screening rates. This study underscores the importance of improving overall lung cancer screening rates, as the majority of the eligible population did not receive screening. Efforts will be made to implement interventions that enhance lung cancer screening rates, ensuring timely detection and improving patient outcomes. Addressing disparities in lung cancer screening access and utilization is crucial for achieving equitable healthcare and reducing the burden of lung cancer on vulnerable populations. Citation Format: Giuseppina Jacob, Amanpreet Dhaliwal, Praveen Namireddy. Disparities in lung cancer screening rates: A retrospective observational study [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 B107.

Preventative cancer screening among African and Afro-Caribbean immigrants.

e22504 Background: In 2021, the U.S. Preventive Services Task Force recommended expanding the population who should undergo routine lung or colorectal cancer screening to include those between 50 and 80, with a 20-pack or more smoking history, and those who are currently smoking or have quit within the last 15 years. According to the Centers for Disease Control, 74.3% of the at-risk population undergo colorectal cancer screening. In contrast, according to the American Lung Association, only 5.8% of the eligible population undergoes lung cancer screening. Methods: This is a retrospective analysis of 158 patients who underwent colorectal cancer screening by colonoscopy between July 2022 and October 2022 at a high-volume hospital in Indiana. Patients were followed up in their primary care office between November 2022 and January 2023 to assess if they had also met the screening criteria for lung cancer with a low dose computed tomography (LDCT) scan. Patients who met the lung screening criteria were interviewed at their subsequent primary care appointment to evaluate their knowledge, attitudes, and compliance with lung cancer screening. Results: Of the 158 participants, 86 (54.4%) met the criteria for lung cancer screening with a LDCT. Only 5 (5.8%) of the eligible subjects underwent LDCT screening. 72 of the 81 patients who were not screened for lung cancer had scheduled follow-ups with their primary care provider during the study time frame. Of these 72 patients, 45 (62.5%) lacked knowledge about LDCT and lung cancer screening, despite meeting the criteria for it. 22 (30.5%) did not think they needed a LDCT, and 5 (6.9%) had no interest in screening despite previous awareness. All 72 patients who had colorectal cancer screening but not lung cancer screening were asked why they underwent the former but not the latter. 68 (94.4%) indicated that colonoscopy was recommended to them and that they knew someone in their families who had it done. Conclusions: Colon cancer screening rates remain high compared to lung cancer screening rates in an at-risk population. A lack of knowledge from patients is the primary reason for not receiving LDCT, despite receiving colon cancer screening.

Background: Lung cancer screening with annual low-dose computed tomography (LDCT) in high-risk patients with exposure to smoking reduces lung cancer-related mortality, yet the screening rate of eligible adults is low. As hospitalization is a critical moment to engage patients in their overall health, it may be an opportunity to improve rates of lung cancer screening. Prior to implementing a hospital-based lung cancer screening referral program, this study assesses the association between hospitalization and completion of lung cancer screening. Methods: A retrospective cohort study of evaluated completion of at least one LDCT from 2014-2021 using electronic health record data using hospitalization as the primary exposure. Patients aged 55-80 who received care from a university-based internal medicine clinic and reported cigarette use were included. Univariate analysis and logistic regression models evaluated the association of hospitalization and completion of LDCT. The secondary outcome was completion of any CT of the chest. Results: Of the 1,935 current smokers identified, 47% had at least one hospitalization, and 21% completed a LDCT during the study period. While a higher proportion of patients with a hospitalization had a LDCT (24%) compared to patients without a hospitalization (18%, p&amp;lt;0.001), there was no association between hospitalization and completion of a LDCT after adjusting for potentially confounding covariates (95%CI 0.680 - 1.149). Of cohort patients, 38% completed any CT of the chest and hospitalization was associated with increased odds of receiving chest CT imaging in the adjusted model (OR 1.72; 95%CI 1.37 - 2.17). Conclusions: In a cohort of patients at risk for lung cancer, only 1 in 5 completed lung cancer screening with LDCT and hospitalization events were not associated with LDCT completion. A hospitalist driven lung cancer screening program has the potential to increase the suboptimal rates of lung cancer screening in high-risk patients. Citation Format: Ellen M. Nielsen, Jingwen Zhang, Justin Marsden, Chloe Bays, William P. Moran, Patrick D. Mauldin, Leslie A. Lenert, Benjamin A. Toll, Andrew D. Schreiner, Marc Heincelman. Hospitalization as an opportunity to improve lung cancer screening in high-risk patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4790.

BackgroundThe United States Preventive Services Task Force (USPSTF) recommends lung cancer screening via annual low dose computed tomography (LDCT) for high risk patients. Despite the strong evidence of a mortality benefit from several randomized clinical trials, rates of lung cancer screening remain low. We plan to assess how screening guidelines are implemented in a radiation oncology clinic for patients with head and neck cancer.MethodsA single institution, retrospective chart review was used to identify patients with head and neck cancer seen in a radiation oncology clinic who were potentially eligible for lung cancer screening under the current USPSTF guidelines. Patients who were potentially screening-eligible were enrolled in a phone survey to assess their knowledge about lung cancer screening and willingness to be screened.ResultsOf the 184 patients with head and neck cancer seen in the clinic, 8 (4%) patients were eligible for lung cancer screening under the previous USPSTF recommendations, including 1 (0.5%) patient already being screened. One patient (0.5%) became eligible under the expanded guidelines. All 184 patients had smoking history documented. Of the 87 current or former smokers, there were 24 (28%) who did not have pack-years documented; of the 82 former smokers, there were 8 (10%) who did not have quit date documented. Among the 16 phone survey participants (response rate: 70%) only 6 (38%) were aware there is a way to screen for lung cancer and 12 (75%) patients would be interested in screening if they are found to be eligible.ConclusionsThese findings highlight a potential opportunity to increase rates of lung cancer screening among patients with head and neck cancer by both enhancing provider awareness as well as patient education at the community level.

Background: Despite the efficacy of low-dose computerized tomography (LDCT) to detect lung cancer early, the rate of lung cancer screening among high-risk individuals remains low. The purpose of this study was to assess lung cancer screening rates in contrast with state lung cancer mortality across the United States. Methods: Data for this study were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from three consecutive years (2018-2020); a population-based survey administered via cell phone and landline and conducted annually by the Centers for Disease Control and Prevention (CDC). Eligibility criteria follow the 2013 U.S. Preventive Services Task Force (USPSTF) recommendation: high-risk individuals aged 55-80 years with a &amp;gt;30 pack-year smoking history who currently smoke or have quit within the past 15 years. After excluding ineligible subjects and those with missing information, 11,297 subjects were included in the final analysis. Multivariable logistic regression models were used to assess the association between the predictor (i.e., state of residence) and the outcome variable (i.e., screening rate). Results: Of the 24 states included in this study, the states with the highest lung cancer screening rates were Rhode Island (24.75%), Vermont (22.51%), New Jersey (21.72%), Minnesota (21.64%), and Delaware (21.39%). The states with the lowest screening uptake were Oklahoma (9.23%), Utah (9.78%), West Virginia (12.23%), South Dakota (12.31%), and Kansas (12.41%). Kentucky has the highest lung cancer mortality and has become the 6th highest in screening rates. Utah has the lowest lung cancer mortality and is the second-lowest state in lung cancer screening rates. After adjusting for sociodemographic (i.e., age, gender, marital status, level of education, income, insurance, and race/ethnicity) and health-related factors (i.e., chronic obstructive pulmonary disease, smoking history, and primary care provider), high-risk individuals in the state of Delaware (OR: 2.85, 95% CI: 1.50 - 5.41), Kentucky (OR: 2.04, 95% CI: 1.03 - 4.04), Minnesota (OR: 2.74, 95% CI: 1.49 - 5.06), Montana (OR: 2.15, 95% CI: 1.09 - 4.25), New Jersey (OR: 2.39, 95% CI: 1.25 - 4.57), Pennsylvania (OR: 2.28, 95% CI: 1.17 - 4.44), Rhode Island (OR: 2.57, 95% CI: 1.33 - 4.98), Texas (OR: 4.51, 95% CI: 2.04 - 9.97) and Vermont (OR: 3.18, 95% CI: 1.61 - 6.28) were significantly more likely to receive lung cancer screening than those in Utah. High-risk individuals in all the remaining states were not significantly different in terms of their lung cancer screening rates compared to Utah. Conclusions: Lung cancer screening rates varied widely across 24 states and did not match with the lung cancer mortality burden in each state. The results from the present study highlights the importance of developing targeted initiatives and policies that enhance the rates of lung cancer screenings in the states that experience a disproportionate burden of lung cancer mortality. Citation Format: Abdi Gudina, M. Patricia Rivera, Charles Kamen, AnaPaula Cupertino. Disparities in lung cancer screening uptake across the United States [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A086.

Lung Cancer Screening Uptake in the United States

e23060 Background: Lung cancer is the leading cause of cancer-related deaths worldwide. The National Lung Screening Trial (NLST) showed that screening for lung cancer with low-dose CT (LDCT) can detect the disease early and reduce mortality rates. It is crucial to optimize LDCT lung cancer screening in high-risk populations in primary care settings to prevent the disease. Despite the United States Preventive Services Task Force (USPSTF) recommendations, LDCT screening rates are low. The 2023 "State of Lung Cancer" report revealed that only 4.5% of high-risk individuals were screened nationally, a decline from 5.8% in 2022. However, Ohio's screening rate of 6.9% was significantly higher than the national average. This study aimed to determine the rate of LDCT screening among tissue-confirmed lung cancers. Methods: The study involved a retrospective analysis of tissue-confirmed non-small cell lung cancer (NSCLC) cases (n = 116) in the tumor registry. The electronic medical records (EMR) of lung cancer patients were reviewed for documentation of LDCT and other registry data, including demographics, histology, clinical and pathological stage, recurrence, and vital status. Results: The accessioned lung cancer patients with NSCLC (adenocarcinoma) had an average age of 67.5 + 10 years, and 60.3% were male, with 9.5% being non-white. The study found that only 24.1% (28/116) of patients with lung cancer had undergone LDCT screening. The mortality rate in the series was 27.61% (32/116). AJCC clinical and pathological stage was associated with mortality (p &lt; 0.05). Among survivors, 7.1% of presentations were pathologically AJCC staged 3 or 4, while among non-survivors, 25.1% of presentations were stage 3 or 4. No difference by stage and LDLCT was noted. The study found that screened patients were younger, with an average age of 64, compared to 69 years for non-screened patients (t = 1.983, p = 0.05). No sex or race differences by screening were observed. Conclusions: During the local enrollment in NLST for NCI, the tumor registry showed a higher proportion of early cancers (stage 1), indicating downstaging. However, no difference in stage by screening was found in the current study. Compared to screening rates for breast, prostate, or colorectal cancer, lung cancer screening rates are low despite the high case lethality of lung cancer. Screening for lung cancer in community hospital settings can improve early detection and patient outcomes. Implementing targeted education campaigns, expanding access to screening services, and optimizing communication between healthcare providers and patients is essential to increasing LDLCT screening rates.

Lung Cancer Screening Rates During the COVID-19 Pandemic

Hospitalization as an opportunity to improve lung cancer screening in high-risk patients

875 Background: Bladder cancer is the 10th most common cancer globally, with 573,278 cases reported in 2020. Tobacco consumption is a major risk factor; smokers have a 3x higher risk of bladder cancer compared to non-smokers. Tobacco consumption is also a risk factor for lung cancer, and current guidelines recommend screening high risk patients. While screening for bladder cancer in the general population is not recommended, screening high-risk bladder cancer populations may be beneficial. We hypothesize that linking bladder cancer screening to lung cancer screening may have higher yield than general population screening and enable earlier bladder cancer diagnosis. Methods: We performed a retrospective review of patients at a single-institution that underwent surgical treatment for urothelial carcinoma (TURBT, ureteroscopy, ureterectomy, nephroureterectomy, or cystectomy) by a single urologic-oncologist from October 2022 to June 2024. Patients were initially referred for microscopic/gross hematuria, badder/upper tract mass, or known urothelial cancer. We collected patient demographics, smoking history and imaging/surgical pathology. We aimed to determine the eligibility of these patients for lung cancer screening programs. Secondary outcomes included rates of lung cancer screening and lung cancer diagnosis. Results: We identified 76 patients with a urothelial carcinoma diagnosis. 87% had bladder cancer and 13% had UTUC. 48 (63%) patients were either current or former smokers, and the mean pack year history was 24 pack years. Of those patients, 14 (29%) met the criteria for lung cancer screening guidelines (ages 50-80, at least a 20 pack year smoking history, and current smoker or quit within 15 years); only 1 patient (7%) had received a screening low-dose CT Chest for lung cancer screening. Out of these 14 patients, 11 (79%) had a concerning finding on CTU. Conclusions: Our analysis highlights that lung cancer screening uptake remains low. In our cohort, 29% met lung cancer screening guidelines at the time of diagnosis. In this high risk population, 79% had concerning findings on CTU. While our results are promising and establish a potential rationale for linking bladder cancer screening to lung cancer screening due to their higher inherent risk, future prospective studies are needed to demonstrate utility and benefit. Patient demographic information. No Smoking History (N = 28) Smoking History (N = 48) Overall (N = 76) Age, Mean (SD) 72.5 (12.2) 72 (9.9) 72.2 (10) Sex (%) Male 20 (71.4%) 35 (72.9%) 55 (72.4%) Female 8 (28.6%) 13 (27.1%) 21 (27.6%) Gross Hematuria Upon Presentation 12 (42.9%) 36 (75.0%) 48 (63.2%) Concerning CTU Findings 14 (50.0%) 31 (64.5%) 45 (59.2%) Taking Blood Thinners 11 (39.2%) 18 (37.5%) 29 (38.2%) CAD/Afibb/Stroke/PE 13 (46.4%) 19 (39.6%) 32 (42.1%) HTN/DM 17 (61%) 25 (52%) 42 (55.2%)

The trajectory of racial/ethnic disparities in the use of cancer screening before and during the COVID-19 pandemic: A large U.S. academic center analysis