National Survey of Lung Cancer Screening Eligibility in United States Veterans

Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the U.S. population over age 50 years meet the U.S. Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown. This study evaluated the proportion of Veterans who are USPSTF-eligible and tested the hypothesis that more USPSTF 2021-eligible Veterans reside in rural versus nonrural areas.

Investigators cross-sectionally surveyed a national sample of Veterans aged 50 years and older January-November 2022. Oversampling ensured inclusion of minority groups and accounted for geographic variation in tobacco use. Analyses in 2023-2024 evaluated the proportion of USPSTF-eligible Veterans by year (2013 and 2021) and tested USPSTF-2021 eligibility by rural status (rural versus nonrural) using chi square tests. Weighting accounted for survey nonresponse and applied results to the whole Veteran population in a sensitivity analysis.

Of 2,000 surveyed, 754 responded (37.7% response rate); most respondents were White (74.4%), male (92.6%), and resided in nonrural areas (66.0%). Proportions meeting USPSTF criteria were 35.5% (95% CI=31.6%, 39.6%) in 2021 and 27.8% (95% CI=24.3%, 31.7%) in 2013. The proportion of USPSTF 2021-eligible rural Veterans (41.2%; 95% CI=34.8%, 48.0%) was higher compared with nonrural (32.5%; 95% CI=27.7%, 37.7%), p=0.037. A sensitivity analysis found the proportion of Veterans USPSTF 2021 eligible in the whole population was 33.0%.

The proportion of Veterans USPSTF2021 eligible was nearly 3 times higher than the general U.S. population (11.2%), and a greater proportion of eligible Veterans resided in rural compared with nonrural areas. These findings are critical for policies aimed at fully implementing lung cancer screening at scale.