National lung cancer screening rates remain low, with some improvement during pandemic

National lung cancer screening rates remained low and unchanged from 2019 to 2020, but rates significantly improved in 19 U.S. states despite the COVID-19 pandemic, according to data published in Chest.

“Previous studies reported 80% to 90% declines in breast, cervical and colorectal cancer screening volumes in March-April of 2020 before rebounding in the summer of 2021, after clinics resumed routine screening,” Stacey A. Fedewa, PhD, senior principal scientist in the department of surveillance and health equity sciences at the American Cancer Society, and colleagues wrote in a letter to the editor. “However, the pandemic’s impact on lung cancer screening rates nationally or by state is not yet known.”

Fedewa and colleagues analyzed data from 564,164 lung cancer screenings performed in 2019 and 557,795 performed in 2020 obtained from the American College of Radiology’s Lung Cancer Screening public reports. Researchers compared lung cancer screening rates for both years.

The primary outcome was lung cancer screening rates among eligible adults, defined according to the U.S. Preventive Services Task Force criteria in 2019 to 2020 as those aged 55 to 80 years who currently or formerly smoked cigarettes and quit within the past 15 years with a smoking history of 30 or more pack-years.

Overall, national lung cancer screening rates remained steady, at 6.6% in 2019 and 6.5% in 2020 (screening rate ratio = 0.99; 95% CI, 0.97-1.01).

Screening rate ratios significantly decreased by 23% to 52% from 2019 to 2020 in Utah, Rhode Island, Vermont, Hawaii and Maryland.

“States’ stay-at-home orders and COVID-19 surges may have influenced short-term screening volumes, although there was not a clear pattern with annual lung cancer screening rates,” the researchers wrote.

From 2019 to 2020, lung cancer screening rates remained unchanged in 50% of U.S. states but significantly increased in 19 states. Nevada, West Virginia, Maine and Kentucky had a 20% or greater improvement in screening rates.

According to the researchers, the lack of decline in the nationwide lung cancer screening rate may be attributable to the underutilization of lung cancer screening before the COVID-19 pandemic, when only 5% to 6% of adults in 2018 received screening. In addition, the improvement reported in 19 states suggests health systems and local and state-level cancer control efforts may play a role in improving these rates, the researchers noted.

“Best practices from successful state and local lung cancer screening programs could inform ongoing efforts to detect lung cancers early,” the researchers wrote.