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Toward Redefining Adherence: The Impact of Adherence Definition on Lung Cancer Screening Program Benchmarks.

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|November 24, 2025
PubMed
Summary

Lung cancer screening follow-up adherence rates vary significantly based on how adherence is defined. Using any chest CT instead of only low-dose CT (LDCT) and allowing longer follow-up times increases reported adherence.

Keywords:
Adherence to follow-uplow-dose CTlung cancer screening

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Area of Science:

  • Pulmonary medicine
  • Radiology
  • Oncology

Background:

  • Annual low-dose CT (LDCT) is recommended for lung cancer screening (LCS) follow-up.
  • Patient adherence to recommended follow-up imaging is inconsistent.
  • Current definitions of adherence vary in timing and imaging type (LDCT vs. routine chest CT).

Purpose of the Study:

  • To evaluate how different definitions of adherence impact LCS follow-up rates.
  • To assess the influence of follow-up time frames and imaging types on adherence.
  • To develop a standardized schema for reporting LCS adherence.

Main Methods:

  • Retrospective study of LCS follow-up in a healthcare system (2016-2023).
  • Binary adherence defined as follow-up chest CT acquisition, evaluated using six definitions.
  • Analysis included three time frames (15, 24, unlimited months) and two CT types (LDCT only vs. any chest CT).
  • A novel four-category adherence schema was developed and applied.

Main Results:

  • LDCT-only adherence rates ranged from 35.6% (15 months) to 55.9% (unlimited months).
  • Adherence increased to 45.8% (15 months) - 68.4% (unlimited months) when including any chest CT.
  • Adherence was significantly higher with longer time frames (P < .001) and inclusion of any chest CT (P < .001).
  • The four-category schema showed distinct rates for on-time, late, never followed up, and not overdue categories, varying by CT type inclusion.

Conclusions:

  • Adherence definitions significantly impact reported lung cancer screening follow-up rates.
  • Standardized definitions are crucial for comparing LCS program performance.
  • The proposed four-category schema provides a comprehensive view of patient screening status within an LCS program.