How Do I Get Screened For Cancer – The US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening for adults aged 55–80 years who have a history of ≥30 pack-years of cigarette smoking and are current smokers or have quit <15 years ago.
In 10 states, one in eight people aged 55–80 years met USPSTF criteria, and among those meeting USPSTF criteria, only one in eight reported lung cancer screening in the past 12 months.
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Public health initiatives to prevent smoking, increase smoking cessation, and increase recommended lung cancer screening may help reduce lung cancer mortality.
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Lung cancer is the leading cause of cancer death in the United States; 148,869 lung cancer-related deaths occurred in 2016 (1). Mortality can be reduced by identifying lung cancer at an early stage when treatment can be more effective (2). In 2013, the US Preventive Services Task Force (USPSTF) recommended annual screening for lung cancer with low-dose computed tomography (CT) for adults aged 55–80 years with a 30 pack-year* smoking history and current smokers or quitters. . Within the last 15 years (2)
It was a Grade B recommendation, requiring health insurance plans to cover lung cancer screening as a preventive service.
To assess the prevalence of lung cancer screening by state, Behavioral Risk Factor Surveillance System (BRFSS) data were used.
Collected in 2017 by 10 states.** Overall, 12.7% of adults ages 55-80 met USPSTF criteria for lung cancer screening. Among those who met the USPSTF criteria, 12.5% reported that they had received a CT scan to screen for lung cancer in the past 12 months. Efforts to educate health care providers and provide decision support tools may increase recommended lung cancer screening.
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The BRFSS is a random-digit-dial landline and cellular telephone survey conducted in conjunction with state health departments of the noninstitutionalized US adult population aged ≥18 years.
In 2017, for the first time, the optional module added questions on lung cancer screening. In combination with the core BRFSS questions on age and cigarette smoking status, three questions
Enabled calculation of cigarette pack-years smoked from the lung cancer screening module. A fourth question asked about receiving CT scans in the past 12 months, with the following possible responses: “Yes, to screen for lung cancer”; “No (no CT scan)”; And “had a CT scan, but for some other reason.”
During January 2017–December 2017.*** Weighted estimates were derived following BRFSS recommendations for alternative modules (3) and using SAS-callable SUDAAN (version 11.0; RTI International) to account for the BRFSS stratified, complex sampling design. . Current, former, and never cigarette smoking status
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(33, 137). Weighted prevalence estimates of smoking status and pack-year categories among adults aged 55–80 years were estimated for each state. Weighted populations for smoking status and pack-year categories were derived by multiplying the state population of persons aged 55–80 years by the weighted percentage of adults in the respective smoking status and pack-year category.
Weighted estimates were calculated for self-reported receipt of lung cancer screening among current and former cigarette smokers (hereafter referred to as smokers) aged 55–80 years (14,585) who did not meet USPSTF criteria for lung cancer screening.* * ** Weighted prevalence of lung cancer screening was calculated by age group, smoking status, sex, race/ethnicity, education, general health status, health care coverage, regular screening in the past year, and diagnosed chronic obstructive pulmonary disease (COPD). ), emphysema, or bronchitis.
Logistic regression was used to calculate prevalence ratios (PRs) with 95% confidence intervals, as reported lung cancer screening results, adjusted for all other variables.
Overall, 12.7% of adults aged 55–80 years met USPSTF criteria for lung cancer screening, nearly half (5.6%) were former smokers (Table 1). The percentage of adults who met USPSTF screening criteria by state ranged from 8.9% (Maryland) to 17.0% (Oklahoma). Population sizes meeting USPSTF criteria ranged from 16,200 (Vermont) to 610,000 (Florida) (Supplementary Table 1, https://stacks./view//85167 ).
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Lung cancer screening was reported by 12.5% of smokers who met USPSTF criteria and ranged from 9.7% (Oklahoma) to 16.0% (Florida) (Table 2). Differences between states ranged from -3.8% (Oklahoma vs. Vermont) to 6.3% (Florida vs. Oklahoma) (Supplementary Table 2, https://stacks./view//85168). Lung cancer screening was reported by 7.9% of smokers aged 55–80 years who did not meet USPSTF criteria and ranged from 4.3% (Maryland) to 9.4% (Oklahoma and Florida) ( Table 2 ). Differences between states ranged from -5.1% (Maryland vs. Oklahoma) to 5.2% (Florida vs. Maryland) (Supplementary Table 2, https://stacks./view//85168).
Among smokers meeting USPSTF criteria, higher prevalence of lung cancer screening was associated with diagnosed COPD (PR=3.01) and lower prevalence of screening with no routine screening in the past year (PR=0.54) (Table 3). Among smokers who did not meet USPSTF criteria, higher prevalence of screening was associated with diagnosed COPD (PR=2.34) and lower prevalence of screening with ex-smoking (PR=0.63) and fair or poor general health status (PR=0.68). .
These findings suggest an opportunity to educate both patients and healthcare providers, provide decision support tools to reinforce appropriate screening triage, and implement evidence-based interventions from community guides.
Previous studies have used data from the 2017 BRFSS optional module on lung cancer screening to analyze utilization by state (4) and sexual minorities (5). This report adds information on prevalence and population size by different categories of pack-year smoking for each participating state. The 2017 BRFSS questions to identify smoking pack-years were similar to questions a healthcare provider might ask in a clinic.
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States can use the BRFSS lung cancer screening estimates to identify where increased screening is needed, develop supplemental research projects to assess barriers to screening,
And to monitor the effectiveness of interventions.***** Annual lung cancer screening is a secondary preventive health care strategy (2). The most effective primary preventive measures for lung cancer are to never start smoking and for smokers to quit as soon as possible (6). The National Cancer Institute and the Veterans Health Administration are currently supporting clinical trials to test smoking cessation intervention strategies for patients undergoing lung cancer screening ( 7 ). 2008 U.S. Evidence-based tobacco cessation interventions in public health service clinical guidelines and community guides include counseling patients to quit smoking, providing cessation advice and medications, and connecting patients to other cessation resources such as 1–800-QUIT-NOW (6). ). Recent studies suggest that primary care providers need to learn how to conduct shared decision-making discussions and implement effective smoking cessation interventions in the context of lung cancer screening (7, 8).
Cigarette smoking is the leading cause of COPD in the United States (9). In the current report, diagnosed COPD was associated with a higher prevalence of lung cancer screening, both among smokers and those who did not meet USPSTF criteria. The severity of reported COPD is unknown. The USPSTF does not recommend lung cancer screening if a health problem is present that substantially limits life expectancy or the ability to undergo curative lung surgery (2).
The findings of this report are subject to at least four limitations. First, lung cancer screening and smoking were self-reported without medical record verification. Self-reported smoking history may be subject to recall bias and social desirability bias. Some respondents may not know the exact type of test they received or the reason their doctor ordered the test. Second, the 2017 BRFSS module does not address whether cessation counseling and medications were provided to current smokers. Third, the module does not provide information on health care resources that may vary by location within a state, such as the distribution of American College of Radiology–accredited lung cancer screening facilities.
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Finally, some caution may be required when comparing these results with results from other surveys. For example, the prevalence of screening in the 2017 BRFSS among adults meeting USPSTF criteria (12.5%) was higher than that reported in the 2015 National Health Interview Survey (4.4%) ( 10 ). Although actual increases in screening delivery may have occurred from 2015 to 2017, differences in methods of data collection, question wording, and populations covered may have led to different estimates.
Public health initiatives to stop smoking, increase smoking cessation, and increase lung cancer screening among those who meet USPSTF criteria may help reduce lung cancer mortality. Avoidance of screening inconsistent with USPSTF criteria may reduce the potential for harms such as overdiagnosis and overtreatment (10). Efforts to educate
Behavioral Risk Factor Surveillance System State Coordinators; William S. Garvin, Carol Pieranunzi, Department of Population Health, National Center for Chronic Disease Prevention and Health Promotion,.
* Pack-years (PYs) are the number of 20-cigarette packs smoked per day multiplied by the average number of years smoked.
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Under Section 2713 of the Patient Protection and Affordable Care Act (ACA), individual and group health insurance plans must provide coverage for evidence-based screening services that have a rating of A or B in current USPSTF recommendations and cannot implement cost-sharing. on patients receiving these services (such as co-payments, deductibles, or co-insurance). In addition, beginning in 2015, the Centers for Medicare and Medicaid Services covered lung cancer screening for Medicare beneficiaries ages 55-77 who met USPSTF smoking criteria.
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