Analysis of Lung Cancer Screening Eligibility among Patients Diagnosed with Lung Cancer: A Retrospective Cohort Study.
PURPOSE We evaluated LCS eligibility rate under USPSTF criteria among patients diagnosed with primary lung cancer and examined LCS utilization prior to lung cancer diagnosis. METHODS Patients aged 50-80 years with a lung cancer diagnosis in 2018-2024 who received care at a tertiary health system in Southern California were included. LCS eligibility was determined using available structured smoking history in the electronic medical record (EMR). The primary outcome was LCS eligibility using 2021 USPSTF guidelines. Secondary outcomes included LDCT completion among LCS-eligible patients during the two years preceding their diagnosis based on USPSTF guideline in effect at diagnosis time, the completeness of EMR structured smoking history, and the associations between sociodemographic characteristics and these outcomes. RESULTS 1,867 patients were included (mean age 67±8 years, 51.6% (962/1866) male, 53.4% (955/1790) White, 2.4% (43/1790) Black, 31.5% (564/1790) Asian). Further, 11.6% (208/1786) were Hispanic. At diagnosis, 46.3% (786/1697) were never smokers, 44.5% (756/1697) former smokers, and 9.1% (155/1697) current smokers. LCS eligibility was determined for 1,119 patients, of whom 13.2% (148/1119) met eligibility criteria according to the 2021 USPSTF guidelines. Multivariable analysis showed women (OR 0.32; 95% CI, 0.21-0.47; P<0.001), Asian race (OR 0.35; 95% CI, 0.20-0.62; P<0.001), other or mixed race (OR 0.48; 95% CI, 0.24-0.97; P=0.04), and Hispanic ethnicity (OR 0.38; 95% CI, 0.17-0.82; P=0.01) were less likely to be LCS-eligible. Among the 137 eligible patients, only 13 (9.5%) had received LDCT. CONCLUSION Our findings emphasize two critical barriers to effective LCS: the limited reach of existing eligibility criteria and inadequate uptake of LDCT.