Geospatial analysis identifies areas with individuals eligible for lung cancer screening
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Key takeaways:
- 29.3 million U.S. individuals are eligible for lung cancer screening.
- 15% of eligible individuals live within 20 minutes of a screening site.
- These data can direct efforts to improve uptake.
HONOLULU — A model that incorporates demographic and smoking history data has identified regions populated with individuals eligible for lung cancer screening, according to study results presented at the CHEST Annual Meeting.
Researchers hope identifying these regions where many individuals may benefit from lung cancer screening will improve uptake and help direct screening programs.
“Geospatial techniques allow us to look at population-level trends as part of identifying next steps in lung cancer screening outreach and resource planning,” Christine Lambert, MD, clinical instructor at University of Minnesota, told Healio. “These maps can potentially be used to see large numbers of current smokers for whom lung cancer screening should be offered alongside counseling on smoking cessation, or screening-eligible women for whom lung cancer screening could be discussed alongside mammograms as part of routine cancer surveillance.”
Lambert and colleagues used these geospatial techniques to estimate the number of individuals eligible for screening based on census tract. They created a model that incorporated current and former smoking prevalence data from the Behavior Risk Factor Surveillance Survey along with demographic and census tract-level data on age, sex and race/ethnicity from the American Community Survey to identify individuals aged 50 to 80 years with a 20 pack-year smoking history and a quit time of less than 15 years, the criteria for lung cancer screening eligibility based on the United States Preventive Services Task Force recommendations.
Lambert noted that the specificity of these criteria, along with other specific challenges, contribute to poor uptake of lung cancer screening.
“At the health system level, availability and ease of screening differ greatly across the country, with many rural patients needing to travel farther to access screening services,” Lambert said. “Prior screening eligibility requirements such as shared decision-making visits and continued requirements around pack-year eligibility can be harder for providers to navigate compared with other types of cancer screening. At the patient level, individuals may feel stigmatized for their smoking history and there is a lot of fear around getting a lung cancer diagnosis as it is known to be a high-mortality cancer.”
Overall, their results identified an estimated 29.3 million individuals eligible for lung cancer screening in the U.S. (white, n = 26.5 million; Black, n = 1.6 million; Hispanic, n = 930,671; American Indian/Alaska Native, n = 208,158; Asian/Pacific Islander, n = 10,793).
Almost half (49.6%) of individuals eligible for lung cancer screening currently smoke, ranging from 41% of those eligible in Connecticut and Vermont to 73% in Tennessee.
Further, researchers calculated the time between each census tract and the nearest lung cancer screening site using the American College of Radiology National Radiology Data Registry. They found that 15% of individuals eligible for screening live within 20 minutes of one of these sites; however, this percentage varied by state, from 3% in New Jersey to 52% in Montana.
These data can be used to target efforts for screening, Lambert said.
“States that are similar in terms of high lung cancer incidence and low 5-year survival can still have unique geographic patterns in terms of screening availability and distance to screening that need to be accounted for when planning for expanding screening capabilities,” she said.
According to Lambert, she and her colleagues hope their model will be used at local, regional and national levels for clinical, public health or health services research.
“We also see it becoming an important tool for public health departments or health care companies as they plan for preventative health and cancer care services,” Lambert said, adding that she and colleagues made a map of their findings of lung cancer screening-eligible individuals in relation to a screening site available online.