Dismal Adherence to Lung Cancer Screening in a Diverse Urban Population.

Abstract

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

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

Results: 6,983 patients received LCS over 10 years. Only 8.13% adhered to T₁, 3.68% at T₂, and 1.35% at T₃. Extending the adherence criteria showed minimal improvement: T₁ 10.54%, T₂ 4.64%, and T₃ 3.47%. At all intervals, males (vs. female; 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 LCS was low (8.13%) and declining each subsequent year, especially among male and Hispanic patients. Targeted education regarding importance of annual LCS is needed to realize the lifesaving potential of LCS.