Lung Cancer Screening Knowledge and Perceived Barriers Among US Physicians

Lung Cancer Screening in the US, 2022

Importance

The US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low-dose computed tomography in high-risk individuals (age 50-80 years, ≥20 pack-years currently smoking or formerly smoked, and quit <15 years ago) for early detection of LC. However, representative state-level LCS data are unavailable nationwide.

Objective

To estimate the contemporary prevalence of up-to-date (UTD) LCS in the US nationwide and across the 50 states and the District of Columbia.

Design, Setting, and Participants

This cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for LCS according to the 2021 USPSTF eligibility criteria. Data analysis was performed from October 1, 2023, to March 20, 2024.

Main Outcomes and Measures

The main outcome was self-reported UTD-LCS (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria in respondents aged 50 to 79 years. Adjusted prevalence ratios (APRs) and 95% CIs compared differences.

Results

Among 25 958 sample respondents eligible for LCS (median [IQR] age, 62 [11] years), 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years or older, and 53.0% had a high school education or less. The UTD-LCS prevalence was 18.1% overall, but varied across states (range, 9.7%-31.0%), with relatively lower levels in southern states characterized by high LC mortality burden. The UTD-LCS prevalence increased with age (50-54 years: 6.7%; 70-79 years: 27.1%) and number of comorbidities (≥3: 24.6%; none: 8.7%). A total of 3.7% of those without insurance and 5.1% of those without a usual source of care were UTD with LCS, but state-level Medicaid expansions (APR, 2.68; 95% CI, 1.30-5.53) and higher screening capacity levels (high vs low: APR, 1.93; 95% CI, 1.36-2.75) were associated with higher UTD-LCS prevalence.

Conclusions and Relevance

This study of data from the 2022 BRFSS found that the overall prevalence of UTD-LCS was low. Disparities were largest according to health care access and geographically across US states, with low prevalence in southern states with high LC burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved LCS rates and reduced disparities.

Examination of provider knowledge, attitudes, and behaviors associated with lung cancer screening among Black men receiving care at a federally qualified health center

The study's goal was to look at providers' knowledge, attitudes, and behaviors regarding lung cancer screening among Black male smokers served by a federally qualified healthcare center. Participants in the study were interviewed in depth. Participants completed a short (5-10 minute) survey that assessed demographics, training, and attitudes toward lung cancer screening. For quantitative data, descriptive statistics were used, and for qualitative data, deductive thematic analysis was used. This study included ten healthcare professionals, the majority of whom identified as Black (80%) and were trained as advanced practice providers (60%). The majority of providers (90%) have heard of LDCT lung cancer screening; however, participants reported only being "somewhat" familiar with the LDCT eligibility criteria (70%). Despite generally positive attitudes toward LDCT, patient referral rates for screening were low. Barriers included a lack of provider knowledge about screening eligibility, a lack of use of shared decision-making tools, and patient concerns about screening risks. The reasons for the low referral rates varied, but they included a preference to refer patients for smoking cessation rather than screening, low screening completion and follow-up rates among referred patients, and a lower likelihood that Black smokers will meet pack-year requirements for screening. Additionally, providers discussed patient-level factors such as a lack of information, mistrust, and transportation. The study findings add to the body of knowledge about lung cancer knowledge and screening practices among providers in FQHC settings. This data can be used to create health promotion interventions aimed at smoking cessation and lung cancer screening in Black males and other high-risk smokers.

Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment

Annual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider-initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers' knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post-LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.