Lung cancer screening among women Veterans within the Veterans’ Health Administration.
Authors: Bourne Garrett , Bail Jennifer , Dell'Italia John , Tanner Nichole , Maurice Nicholas , Das Devika Govind 
Published: June 2024

10537

Background: Despite advancements in survival rates, lung cancer remains the leading cause of cancer-related deaths among women in the United States (US). In response to this challenge, the United States Preventive Services Task Force (USPSTF) issued updated guidelines in 2021 to broaden the pool of eligible candidates for lung cancer screening (LCS). Pioneering initiatives, such as the Lung Cancer Screening Demonstration Project (LCSDP) launched by the Veterans Affairs (VA) in 2012, have played a pivotal role in evaluating the feasibility of implementing Low-Dose Computed Tomography (LDCT) at eight Veterans Affairs Medical Centers (VAMC). Subsequently, the program has undergone substantial expansion. Projections within the veteran community indicate a notable increase in the proportion of women veterans, from 11% in 2023 to an anticipated 18% in 2048. However, scant information is currently available regarding the lung cancer screening patterns within this expanding demographic. Methods: Women veterans ages 55 -80, current or former smokers from 2015- 2021 were identified through the VA corporate data warehouse (CDW). ICD 9/10 codes were used to identify women veterans with a lung cancer diagnosis. Diagnoses were verified via chart review. Data were analyzed using R Studio software. Results: Of the women veterans identified (n=44,342), 10,623 received LCS (24%) and 942 (2%) had a primary diagnosis of lung cancer. In the cohort of 942 women diagnosed, 286 (30%) had received lung cancer. Women veterans diagnosed with lung cancer tended to be aged >65 (55%), white (72%), single (72%), unemployed (71%), and urban dwelling (70%) within the southeastern US (35%). Compared to women veterans who did not receive LCS, those who did had higher rates of localized disease (47% vs 34%) and lower rates of metastatic disease (12% vs 19%). Factors associated with higher rates of LCS included mammography (60% vs 49%), a family history of lung cancer (4% vs 2%) and living in the southeastern US (46% vs 35%). It is to be noted that 23% of the women veterans who were screened lived in rural areas and 18.53% identified as black. 98.9% of the women had reported current or former tobacco use but the data on pack year history was missing in 87.6% of charts. Conclusions: While further progress can be made, it is notable that 24% of women veterans received LCS, surpassing national averages. This discrepancy underscores the potential to advance efforts in establishing a comprehensive and structured lung cancer screening initiative, thereby facilitating the equitable inclusion of historically marginalized groups, particularly minorities and rural populations. The findings emphasize the imperative to overcome existing impediments to nationwide enrollment and retention in LCS. Lastly, the study underscores the necessity for increased resource allocation towards tobacco cessation initiatives as an integral component of the broader expansion strategy.