Challenges and Opportunities for Lung Cancer Screening in Rural America

Rural populations have higher rates of smoking and both lung cancer incidence and mortality compared with their urban peers. As such, it is imperative that high-risk, rural populations have access to recommended low-dose CT (LDCT) screening, which can detect lung cancer at an earlier, more treatable stage. Data from the 2015 National Health Interview Survey, a nationally representative survey, were analyzed to assess nonmetropolitan-metropolitan and geographic differences in LDCT utilization among screening-eligible individuals. Screening uptake did not differ by nonmetropolitan vs. metropolitan status (3.72% and 3.83%, respectively). Regional uptake varied from 1.58% in the West to 10.11% in the Northeast. Additionally, nonmetropolitan populations represent a disproportionately high 23% of the screening-eligible population despite accounting for only 15% of the US population. There are two key challenges to high-quality LDCT screening experienced by rural populations: (1) geographic access to LDCT screening programs and (2) provider-patient communication. Despite the increased availability of LDCT screening centers since 2015, which is when most insurance plans began to cover the costs of screening, centers are geographically maldistributed relative to the rural-urban and regional need. Although decision aids can facilitate discussion between providers and patients regarding the risks and benefits of LDCT screening, research on the uptake and utility of these tools in rural areas is very limited. Analyses of population-based surveys and administrative and clinical data are needed to continue to surveil screening utilization, elucidate predictors of screening use, and inform shared decision-making tools and interventions for at-risk rural populations.