Centralized lung cancer screening programs improve adherence: JAMA
USA: People enrolled in centralized screening programs have higher adherence to annual screening for lung cancer even if the initial CT scan is negative, finds a recent study. The results, published in JAMA Network Open, support the value of centralized screening programs and the requirement to further implement strategies that improve adherence, to realize the mortality benefit associated with annual lung cancer screening.
Adherence to annual screening with low-dose computed tomography scans is essential for lung cancer screening to confer mortality benefit. The National Lung Screening Trial had an adherence rate of 95%y. But current data are limited on screening adherence across diverse practice settings in the US.
Against the above background, Lori C. Sakoda, Division of Research, Kaiser Permanente Northern California, Oakland, and colleagues aimed to evaluate factors and patterns associated with adherence to annual screening for lung cancer after negative results of a baseline examination, particularly in centralized vs decentralized screening programs.
For this purpose, the researchers conducted an observational cohort study at 5 academic and community-based sites in North Carolina and California. It included 2283 individuals screened for lung cancer between July 1, 2014, and March 31, 2018, who met US Preventive Services Task Force eligibility criteria, had negative results of a baseline screening examination (American College of Radiology Lung Imaging Reporting and Data System category 1 or 2) and were eligible to return for a screening examination in 12 months.
The screening program type was classified as centralized if individuals were referred through a lung cancer screening clinic or program and as decentralized if individuals had a direct clinician referral for the baseline low-dose computed tomography scan.
Adherence to annual lung cancer screening was defined as a second low-dose computed tomography scan within 11 to 15 months after baseline screening.
Key findings of the study include:
- Among the 2283 eligible individuals (56.7% men mean age, 64.9 years; 50.8% were aged ≥65 years) who had negative screening results at baseline, overall adherence was 40.2% (n = 917), with higher adherence among those who underwent screening through centralized (46.0%) vs decentralized (35.3%) programs.
- The independent factor most strongly associated with adherence was type of screening program, with a 2.8-fold increased likelihood of adherence associated with centralized screening (adjusted odds ratio [aOR], 2.78).
- Another associated factor was age (65-69 vs 55-59 years: aOR, 1.38; 70-74 vs 55-59 years: aOR, 1.47).
"After negative results of a baseline examination, adherence to annual lung cancer screening was suboptimal, although adherence was higher among individuals who were screened through a centralized program," wrote the authors. "These results support the value of centralized screening programs and the need to further implement strategies that improve adherence to annual screening for lung cancer."
The study titled, "Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings," is published in JAMA Network Open.