Lung cancer screening rates with low-dose computed tomography (LDCT) were very low among eligible patients across types of insurance in 2017, with rates varying among patient demographics, according to a study published in Journal of the American College of Radiology.1
LDCT screening is covered and has no out-of-pocket costs for eligible patients regardless of coverage type. However, the study found that among individuals with commercial, Medicare, or Medicare Advantage insurance who were estimated to be eligible for screening in 2017, only 1.75%, 3.37%, and 4.56%, respectively, were screened.
Lung cancer is deadly if not caught early, so it is worrisome that Americans at risk are not getting the screening needed for early detection. The current situation, said study author Bob Smith, PhD, senior vice president of early detection cancer sciences at the American Cancer Society.2
Eligibility criteria in 2017 included individuals between the ages of 55 and 77 with a smoking history of up to 30 years and who currently smoke or have quit within the past 15 years. In light of new evidence, these guidelines were revised in 2021 to include individuals ages 50 to 80 with a smoking history of up to 20 years who currently smoke or have quit within the past 15 years.
Although financial barriers have been removed for most insured individuals, the authors highlight several potential barriers to screening that may persist: the clinical challenge of identifying individuals eligible for screening based on history of tobacco use, low referral rates from primary care physicians, and a lack of health insurance. In patients under 65 years of age who would be eligible for screening, lack of access to an LDCT facility, and concerns about cost-sharing that may arise from recoveries after a positive LDCT test.
The current study used data from Optum’s Clinformatics Data Mart that included 2,204,652 merchants and 3,230,763 Medicare Advantage enrollees aged 55-77 in 2017; and data from the 5% CMS Research Profiles (RIF) that included 1,441,328 Medicare fee-for-service (FFS) enrollees in 2017.
Researchers estimated and compared LDCT screening rates between insurance types, enrollee demographics, and geographic characteristics based on the 2017 United States Preventive Action Task Force (USPSTF) eligibility criteria. Of a total of 6,876,743 enrollees, researchers estimated that 1,077,142 (15.7%) They were eligible for lung cancer screening based on the 2017 USPSTF criteria.
Overall, the estimated screening rate was 1.75% among individuals with commercial insurance plans, 3.37% in patients covered by Medicare FFS, and 4.56% for those enrolled in Medicare Advantage. The lowest screening rates were seen in females, individuals ages 75 to 77, people living in rural areas, and those living in the West.
In Medicare FFS enrollees with race/ethnicity data available, non-Hispanic whites had the highest screening rate (3.71%), followed by black non-Hispanic enrollees (2.17%) and enrollees classified as “Other” in the 5% RIF data ( 1.68%).
“These findings suggest that efforts targeting historically vulnerable populations could present opportunities for huge public health gains,” said Danny R. Hughes, PhD, professor at Arizona State University and senior author of the study. “Together, these data can inform practitioners and policymakers on how best to direct efforts to increase lung cancer screening in vulnerable populations.”
The results are largely in line with previous estimates of the use of LDCT screening, with some differences between subgroups. The authors note several limitations, including non-generalizability to Medicaid or the uninsured population, as well as to commercial insurance providers not included in the study sample. Reliance on self-reported smoking data is another limitation.
Overall, the findings underscore the need for future research to explore potential barriers that lead to extremely low LDCT screening rates for those at high risk of developing lung cancer.
“We hope this publication serves as a call to action to explore strategies to increase screening and save lives,” said study author Elizabeth Y. Rolla, PhD, executive director of the Harvey L. Nieman Institute for Health Policy.
1. Hughes DR, Chen J, Wallace E, et al. Comparison of lung cancer screening eligibility and utilization among commercial care, Medicare, and Medicare Advantage enrollees. J Am Cole Radiol. 2023; 20 (4): 402-410. doi: 10.1016/j.jacr.2022.12.022
2. Lung cancer screening rates are very low, and are the worst among the commercially insured. New release. Harvey L Nieman Institute for Health Policy. March 29, 2023. Accessed April 14, 2023. https://www.neimanhpi.org/press-releases/lung-cancer-screening-rates-extremely-low-worst-among-the-commercially-insured/