Lung cancer screening among people with HIV, 2018-2023
TL;DR
Understanding barriers to screening is needed to improve lung cancer outcomes among PWH, even among a high-risk population in the Southeastern United States.
Abstract
Background Lung cancer is the leading cause of cancer-related death among persons with HIV (PWH) in the United States. Annual screening with low-dose chest computed tomography may reduce mortality, but uptake remains unclear. We sought to characterize lung cancer screening eligibility and uptake among PWH engaged in HIV care at a Southeastern tertiary care center. Methods A cross-sectional analysis with 6 time points corresponding to each calendar year from 2018 through 2023 among PWH receiving care. Data were collected from electronic health records, clinical event adjudications, and patient-reported outcomes. Prevalence differences and 95% CIs were estimated across demographic and clinical characteristics. Results Among 2798 PWH in care, 74% were men, 57% identified as non-Hispanic Black and the median age was 48 years (IQR: 35-57). Among all PWH, 62% had a history of smoking with a median pack-year history of 40 (IQR: 27-50) and 51% of these were current smokers. The proportion of PWH meeting United States Preventative Services Task Force screening criteria increased from 6% in 2018 to 15% by 2023 (p < 0.05). Overall, 13% of PWH were eligible for screening, among whom less than one-third (27%) received screening at least once during follow-up. Annual screening was 11% and 24% in 2018 and 2023, respectively, (p = 0.10). Conclusions Lung cancer screening utilization remains low, even among a high-risk population in the Southeastern United States. Understanding barriers to screening is needed to improve lung cancer outcomes among PWH.