Geographic analysis reveals gaps in LDCT lung screening access

Despite a growing number of institutions offering low-dose CT (LDCT) lung cancer screening programs, their geographic distribution is uneven, and some populations who are most at need may be left without access.

Most LDCT screening centers are in the Northeast and East North Central states, though several states with high lung cancer burden and smoking rates—namely Oklahoma, Nevada, Mississippi and Arkansas, West Virginia and Missouri—had little to no LDCT screening center access, according to a study published in the September issue of Lung Cancer.

“As guidelines are implemented and reimbursement for LDCT screening follows, equitable access to LDCT screening centers will become increasingly important, particularly in regions with high rates of lung cancer incidence and smoking prevalence,” wrote Jan M. Eberth, PhD, of the Arnold School of Public Health at the University of South Carolina, and colleagues.

Eberth and colleagues looked for screening centers in the Lung Cancer Alliance Screening Centers of Excellence database as well as surveyed members of the Society of Thoracic Radiology members to identify and map the location of 203 LDCT screening centers.

They found that the average number of centers per state was four, amounting to 0.3 centers per 100,000 people aged 55-79. Centers were most highly concentrated in the Northeast in counties with high lung cancer incidence and mortality, though screening capacity was lower in states in the South and Northwest.

“Our geographical analysis of population density and screening center locations suggests that rural residents face significant barriers in obtaining access to LDCT screening,” wrote the authors. “Among these populations, obtaining services is not merely a matter of commuting to the closest metropolitan area, but may require ‘cross-state’ travel.”

Eberth and colleagues noted that Kentucky, which has high smoking lung cancer rates, had the 10th best screening capacity in the country, suggesting that initiatives such as the Kentucky Cancer Consortium Lung Cancer Prevention and Early Detection Network were being effective.

The authors also suggested a different approach to assessing regional need for a screening center. Instead of using current smoking prevalence as a proxy, which does not take into account smoking over a lifespan, it may be useful to use a retrospective proxy such as smoking prevalence from 20-30 years ago. Eberth and colleagues acknowledged, though, that data on county-level smoking prevalence may not be available prior to the late 1990s.