Abstract 5776: Factors associated with low-dose CT lung cancer screening adherence in a high burden state
Authors: Sedani Ami E. , Ford Lance , Beebe Laura 
Published: September 2020

Background: Lung cancer is the leading cause of cancer death in the U.S. The burden of lung cancer varies substantially by region and state, primarily due to historical differences in the prevalence of cigarette smoking. As of 2013, the United States Preventive Services Task Force (USPSTF) recommends lung cancer screening (LCS) with low-dose computed tomography (LDCT) for those meeting eligibility criteria. Given the recency of this recommendation, studies regarding eligibility and participation are sparse. Identifying screening participation rates and subpopulations with lower participation is an essential first step for planning targeted interventions. Therefore, the purpose of this study was to examine LCS eligibility, utilization, and factors associated with self-reported adherence in Oklahoma, a state with a high smoking prevalence rate and low lung cancer survival rate.

Methods: Starting in 2017, CDC released an optional Behavioral Risk Factor Surveillance System (BRFSS) module for LCS. Data from 596 LDCT eligible participants from the 2017 and 2018 Oklahoma BRFSS surveys were used for this study. This analysis was restricted to data from individuals eligible for screening based on USPSTF guidelines. Univariate analyses using Rao-Scott Chi-square tests were performed to test for differences in the characteristics of those screened and not screened. Weighted logistic regression models were conducted to examine the importance of independent variables in odds of LCS services.

Results: Approximately 5.0% of Oklahomans were eligible for LCS. Only 11.31% (95% CI: 8.02, 14.60) of eligible Oklahomans reported participating in LCS. Asthma diagnosis (p=0.0327), chronic obstructive pulmonary disease (COPD) diagnosis (p&lt;0.0001), and general health status (p=0.0141) were all significantly associated with screening participation; however, urban/rural status (p=0.091), insurance status (p=0.9272), veteran status (p=0.2508), multiple chronic conditions (p=0.0624), and current smoking status (p=0.5099) were not. After adjusting for age, socio-economic factors (income, education, race), asthma status and general health status, the odds of participating in LCS was higher (OR=2.85; 95% CI: 1.40, 5.76; p=0.0037) among those with COPD compared to those without COPD. After the same adjustments the odds of LCS, specifically for males, was even greater among individuals with COPD (OR= 5.86; 95% CI: 2.36, 14.57; p=0.0002) than those without COPD; however, this relationship was not true for females (OR= 0.75; 95% CI: 0.27, 2.08; p=0.5744).

Conclusion: Despite the known benefits of LCS, utilization remains suboptimal among individuals in a high-risk state. State estimates and identification of factors associated with LCS adherence may help inform LCS interventions.

Citation Format: Ami E. Sedani, Lance Ford, Laura Beebe. Factors associated with low-dose CT lung cancer screening adherence in a high burden state [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5776.