Abstract PO-244: Geographic relationship between U.S. lung cancer screening sites and patient prevalence and demographics in the Medicare Fee-for-service program
Authors: Piovanetti-Rivera Ingrid B. , Roy Upal Basu , Regnante Jeanne M. , Stair Taylor , Murray Mary Stober 
Published: December 2020

Abstract
Lung cancer (LC) is the leading cause of cancer mortality in the United States. Smoking history and age (55-80) are eligibility criteria for LC screening. Lung Cancer Screening Centers of Excellence (SCOE) is a designation of the Go2 Foundation for Lung Cancer, which recognizes medical facilities for high-quality low-dose CT screening for early detection and coordinated process for appropriate follow-up and treatment. It is critical to study the geographic relationship between US LC SCOEs and LC prevalence among Medicare beneficiaries to improve access to the cancer continuum of care (CCC), especially for racial and ethnic minorities (REMs). Research question: To what extent do LC SCOE accessibility reflect the reality of LC patient prevalence and demographics in the US? Methods This work builds off on earlier research related to the domains of the CCC established by the IOM/NASEM. Researchers used the following three primary data sources: (1) Medicare Fee-for- Service (FFS) patient-level claims data from 2016, including the following data elements: prevalence, co-morbidities, hospital encounters, and costs for patients with ICD-10 codes for NCSLC and SCLC, by demographic (age, gender, race, and ethnicity). Geographic levels included zip code, county and state and were designated as high (greater than 0.87%) or low (less than 0.87%) prevalence, based on national average prevalence. (2) Screening Center placement data was sourced from 2020 Go2 Foundation for SCOEs. Researchers added zip codes for each SCOE facilitate analysis. (3) Researchers mapped data on the Lung Cancer Index™, a National Minority Quality Forum (NMQF) geographic information system (GIS).
Preliminary Findings 1. There are 26,388 zip codes where Medicare beneficiaries with LC reside; of these, 7,757 zip codes (29.4%) show LC prevalence higher than the national average of 0.87%. 2. SCOEs are located in only 658 zip codes of the 26,388 zip codes with Medicare beneficiaries with LC. 3. There is variation in the location of SCOEs by LC prevalence. Only 99 of the 658 centers were located in areas of high prevalence suggesting that only 0.012% of high prevalence zip codes are served by SCOEs. 4. Additional analysis is ongoing to understand barriers to LC screening in areas with a high density of REMs, including examining prevalence of tobacco usage and in-depth interviews with community leaders. Conclusions Preliminary findings suggest that there is a dearth of Lung Cancer SCOEs in zip codes where there is a high prevalence among Medicare beneficiaries. The advent of precision medicine creates urgency to improve LC screening rates in general and especially for REMs, to generate equitable access to the cancer continuum of care. Lung cancer prevalence data can be a critical guide to screening center placement and care navigation.
Citation Format: Ingrid B. Piovanetti-Rivera, Upal Basu Roy, Jeanne M. Regnante, Taylor Stair, Mary Stober Murray. Geographic relationship between U.S. lung cancer screening sites and patient prevalence and demographics in the Medicare Fee-for-service program [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-244.