Lung Cancer Screening Utilization After Changes in the USPSTF Lung Cancer Screening Guidelines: Results from the 2023 Behavioral Risk Factor Surveillance System

Purpose: Lung cancer screening (LCS) with low-dose chest CT reduces lung cancer mortality. In 2021, the USPSTF expanded LCS eligibility by reducing pack-year thresholds from 30 to 20 and reducing minimum age thresholds from 55 to 50 years old. The objective of the current study was to estimate LCS utilization following the USPSTF guidelines update and assess its association with sociodemographic characteristics using survey data from the 2023 Behavioral Risk Factor Surveillance System (BRFSS).

Methods/Materials: The BRFSS is a nationally representative, cross-sectional telephone survey of adults in the United States (response rate - 44.7%). The 2023 survey included questions regarding LCS eligibility and utilization in 6 states (California, Georgia, New Jersey, Maine, Kansas, and Maryland). The primary outcome was the percentage of patients (50-79 years old with a smoking history of >20 pack-years) who reported undergoing LCS. Logistic regression analyses evaluated the association between LCS and sociodemographic characteristics, accounting for complex survey design elements. P values < 0.05 were considered statistically significant.

Results: Of a total of 31,634 participants across 6 states, 2.9% were eligible for LCS. Of the eligible patients, 35.6% reported undergoing LCS (95% CI 29.8% to 41.8%). LCS utilization ranged from 31.3% in Kansas to 48.4% in Maine (Figure 1). In our multiple variable logistic regression analyses, increasing income categories (p = 0.0127) and increased age categories (p = 0.001) were associated with increasing LCS utilization. Race, ethnicity, health insurance, education, and employment were not associated with differences in LCS utilization (p > 0.05).

Conclusions: The results of our study suggest that LCS utilization following the 2021 USPSTF guidelines update has continued to increase compared to before. However, LCS use among eligible participants remains low, especially when compared to other covered cancer screening services. This suggests opportunities for continued outreach and development of LCS screening programs along with targeted study to assess LCS screening in high-risk groups.