State Disparities in Lung Cancer Screening Uptake Despite Facility Availability in the United States, 2024-2025: A Cross-Sectional Ecological Study.
TL;DR
The findings reveal that solely increasing the number of LCS facilities, even when accounting for the number of recommended at-risk populations, may not necessarily lead to an increase in LCS prevalence for at-risk populations.
Abstract
IntroductionLung cancer screening (LCS) provides substantial advantages as a secondary prevention strategy, yet screening rates remain low, with notable regional disparities. Our cross-sectional ecological study examined the variations in the density of LCS facilities and the LCS prevalence among at-risk populations across states.MethodsWe used the 2024 Behavioral Risk Factor Surveillance System data to estimate the weighted LCS prevalence among at-risk populations, defined as former/current smokers aged 50-80 years with ≥20 pack-year smoking history. We categorized individuals who had a CT (computed tomography) or CAT (computerized axial tomography) scan for LCS within the past year as having a recommended LCS. The facility list was compiled from the American College of Radiology-LCS Registry accessed in February 2025. The density of LCS facilities, defined as the number of facilities per 100,000 estimated at-risk populations, was employed to account for the varying screening-recommended population sizes in each state.ResultsVermont had the fewest absolute number of facilities (9), while Florida had the most (669). However, Maine had the lowest LCS facility density (13.3), while D.C. had the highest (65.7) per 100,000 at-risk populations. The LCS prevalence was not significantly correlated with the absolute number (r=0.0144, p=0.9208) or density (r=0.0424, p=0.7698) of LCS facilities, but it significantly varied across states, ranging from 12.1% (95% confidence interval: 8.6%-15.6%) in South Dakota to 29.9% (23.8%-36.0%) in Connecticut.ConclusionsOur findings reveal that solely increasing the number of LCS facilities, even when accounting for the number of recommended at-risk populations, may not necessarily lead to an increase in LCS prevalence for at-risk populations. A comprehensive geospatial analysis of the distribution of LCS facilities could potentially provide fundamental insights into regional disparities in LCS prevalence by employing the issue of potential spatial mismatches in the arrangement of LCS facilities relative to the geographic distribution of need.