Is Awareness of Low-Dose Computed Tomography (CT) Lung Cancer Screening Critical to Participation in Screening?

Background: Lung cancer is the second most common cancer and the leading cause of cancer death in the United States (Smith et al., 2017). Yet in recent years, only 2-4% of the 8.7 million American citizens eligible for screening reported obtaining chest CT screening for lung cancer (Siegel et al., 2017). Low-dose computed tomography (LDCT) for lung cancer screening has shown promising outcomes for early detection and diagnosis. Annual LDCT screening reduced the relative risk of death from lung cancer by 20% among a high-risk population (Cater-Harris et al., 2016). Prior studies also indicated that lung cancer screening improved patients' quality of life by reducing disease- and treatment-related morbidity, reducing patients’ anxiety and other psychosocial burdens of lung cancer (Carter-Harris, Ceppa, Hanna, & Rawl, 2017). It is critical to be aware of lung cancer screening for early diagnosis and treatment.

Purpose: The present study proposed to explore levels of awareness and receipt of lung cancer screening and factors associated with receipt, as well as to examine the relationship between lung cancer screening awareness and receipt of screening.

Methods: The present study applied Andersen’s behavioral model as the conceptual framework. Upon receiving approval from the University of Minnesota Institutional Review Board, 733 adults aged 18 years or older were recruited in 2016. Of those participants, 242 older adults aged 50 and above were analyzed for the factors associated with receipt of lung cancer screening. Multiple logistic regression was applied to investigate how predisposing (gender, age, marital status), enabling (educational level, monthly household income, annual health check-ups, frequencies of doctor visits, and lung cancer screening awareness), and need factors (health insurance, family cancer history, and self-reported health status) are associated with receipt of lung cancer screening.

Results: Less than twenty percent of participants (19.4%) had received LDCT chest for lung cancer screening. Among those who had lung cancer screening, 58.65% of respondents reported that they had it five or more years prior. Particularly, compared to participants aged 50-59 years old, participants aged 60-69 years old (OR = 2.976, 95% CI = 1.201-7.370) and aged above 70 years (OR = 8.416, 95% CI = 1.786-39.653) were more likely to have lung cancer screening. Compared to participants who visited a doctor once a year or less, those who visited a doctor once every 2 months or more were more likely to have lung cancer screening (OR = 5.869, 95% CI = 1.169-29.465). However, participants who were married or partnered were significantly less likely to have had lung cancer screening (OR = 0.422, 95% CI = 0.180-0.990). Awareness of lung cancer screening was strongly linked to the receipt of lung cancer screening (OR = 25.147, 95% CI = 3.090-204.672).

Conclusion: Low awareness and low healthcare use were strongly linked to lower receipt of lung cancer screening. Improving awareness of lung cancer screening and increasing the number of routine doctor visits may encourage at-risk individuals to actively engage in preventive lung cancer screenings, which in turn can reduce mortality from lung cancer in the United States.