Dismal adherence to lung cancer screening in a diverse urban population

Objectives: High-risk populations for lung cancer, including Black men and those with lower socioeconomic status, experience worse outcomes when treated. The mortality benefit of lung cancer screening cannot be realized without adherence to annual screening. Our study aims to understand annual adherence to lung cancer screening in a population traditionally experiencing health disparities, thus identifying lung cancer screening's impact on lung cancer disparities.

Methods: A 10-year retrospective review of patients obtaining initial lung cancer screening (T₀) at a safety-net institution was performed. Adherence was defined as lung cancer screening completed 12 to 15 months from prior screening (1 annual = T₁, 2 annual = T₂, 3 annual = T₃). Extended adherence was defined as lung cancer screening completed 12 to 18 months from prior screening. Data were stratified demographically for comparative analysis.

Results: A total of 6983 patients received lung cancer screening over 10 years. Only 8.13% adhered to T₁, 3.68% adhered to T₂, and 1.35% adhered to T₃. Extending the adherence criteria showed minimal improvement: T₁ 10.54%, T₂ 4.64%, and T₃ 3.47%. At all intervals, male patients (vs female patients; T₁: 7.37% vs 9.04%, T₂: 3.39% vs 4.11%, T₃: 2.06% vs 2.33%) and Hispanics (vs Black and White; T_1: 7.82% vs 8.53% vs 9.47%, T₂: 2.12% vs 3.42% vs 5.12%, T₃: 1.02% vs 1.69% vs 3.30%) had worse adherence. A small cohort presented early (1-11 months), a form of adherence not previously reported.

Conclusions: In a safety-net institution with a diverse population traditionally experiencing disparities, adherence to annual lung cancer screening was low (8.13%) and declining each subsequent year, especially among male and Hispanic patients. Targeted education regarding importance of annual lung cancer screening is needed to realize the lifesaving potential of lung cancer screening.