Underutilization of low-dose computed tomography in a high-risk population.

Abstract

e14145 Background: Lung cancer is the leading cause of cancer death in the United States, contributing to one-quarter of all cancer-related deaths. State statistics reveal per capita that Kentucky has the highest incidence and mortality rate for lung cancer. One would assume that in a community setting in Kentucky, the rate of utility of low dose Computed Tomography (CT) and detection of lung cancer would be high. Methods: We did a retrospective analysis of Low Dose Computed Tomography (CT) for lung cancer screening based on the United States Preventative Services Task Force (USPSTF) guidelines from 2017-2019 at a community hospital in Ashland, Kentucky. Charts were reviewed to analyze the number of patients who received screening, total number of patients diagnosed with lung cancer, and how many patients could have received screening based on the guidelines. We also analyzed how many are alive and those that are deceased. Results: Our analysis showed that a total of 175 patients were diagnosed with lung cancer at the hospital in 3 years. Out of these, 118 had qualified for screening (67%) based on USPSTF guidelines. Only seven patients received screening (5.9%). All seven patients who received screening are currently alive. Forty-eight patients (41%) are now deceased that could have had the screening but did not. Conclusions: Low dose screening CT is being underutilized in the community setting with high incidence and mortality from lung cancer. The mortality rate is high likely from the late detection of the tumor. Implementation of guidelines to the general population for lung cancer screening will require systems to facilitate identifying eligible patients. It also involves training of physicians with information that should be delivered during the shared decision-making conversation. We also suggest low dose screening CT to be included in global quality pay for performance program for primary care providers which includes screening for breast and cervical cancer as well as smoking cessation.