Paltry use of CT for lung cancer screening persists across all payer types

Uptake of CT-based lung cancer screening is miniscule, regardless of a patient’s health plan, according to a new analysis published Wednesday in the Journal of the American College of Radiology [1].

Among more than 1 million enrollees eligible for such exams, only about 3.2% were actually imaged for lung cancer in 2017. That included 1.7% of patients covered by commercial insurers, 3.4% of those in traditional fee-for-service Medicare and 4.6% of individuals holding advantage plans.

Those residing in remote geographies, along with Black patients covered by traditional Medicare, also were much less likely to undergo low-dose CT, the data show.

“Although screening rates were low across all subgroups examined, there appear to be substantial disparities in LDCT usage among rural nonwhite populations,” Danny R. Hughes, PhD, with the College of Health Solutions at Arizona State University, and co-authors concluded. “Although LCS rates are increasing, albeit slowly, now is the time to identify disparities and underutilization across states and within the population groups eligible for screening. Efforts specifically targeting historically vulnerable populations could present opportunities for outsized gains to public health.”

Investigators utilized smoking-rate data from the County Health Rankings to help estimate eligibility numbers. They tied that together with information from two large databases, representing 5% of nationwide Medicare fee-for-service enrollees and 100% of those covered by large commercial and Medicare Advantage carriers.

The criteria turned up a total of 1,077,142 individuals eligible for lung cancer screening. Uptake was lower among females (1.5% to 4%), patients age 75 to 77 (0.6% to 2.9%), rural residents (1.9% to 3.6%) and in western parts of the U.S. (1.2% to 3.6%). Screening also was higher for white patients covered by FFS Medicare (3.7%) when compared to their Black (2.2%) and other nonwhite counterparts (1.7%). Race-related data was not available from commercial plans.

Regardless of payer, those residing in northeastern parts of the country saw much higher rates of uptake compared to other geographies, possibly attributable to greater availability of accredited facilities.

Hughes et al. highlighted a lack of awareness about LCS programs as a possible driver of low imaging rates among Black patients. The results highlight an opportunity to educate patients about such programs and engage with their primary care providers, the authors suggested. Uptake remains low, despite LDCT screening being made available at no cost to those with insurance, they noted.

“We hope this publication will serve as a call to action to explore strategies to increase screening and save lives,” Elizabeth Y. Rula, PhD, executive director of the Neiman Health Policy Institute, which provided funding for the study, said in a statement.