Examining trends in lung cancer screening over 10 years: Eligibility, participation, cancer detection, and quality...

More than a decade ago, the National Lung Screening Trial led to the recommendation of low-dose computed tomography (CT) for lung cancer screening (LCS). However, few studies have explored how program changes and external factors affect patient outcomes.

This retrospective study included LCS-eligible individuals from Kaiser Permanente Colorado between May 1, 2014, and December 31, 2024. Rates and proportions of LCS orders, completions, adherence to recommended follow-up after baseline screening, and lung cancer yield were calculated. Multivariable log-binomial regression models estimated the factors associated with baseline LCS completion.

Of 23,602 LCS-eligible individuals, 13,576 (58%) received a baseline LCS order and 8621 (37% of eligible; 64% of orders) completed screening. LCS completion was more likely among Asian/Native Hawaiian/Pacific Islander or Black races, and individuals who formerly smoked, had a 20- to 29-pack-year smoking history, >1 specialty care visit, a family history of lung cancer, or a greater comorbidity burden. Overall adherence to recommended follow-up was 62%; patients with a Lung CT Screening Reporting and Data System (Lung-RADS) score of 4B or 4X had the highest adherence at 88%. LCS yielded 424 cases of lung cancer (5% of screened), with 68% at stage I, II, or IIIA. Cumulative incidence among those with a positive Lung-RADS score was 20% at 10 years. Secular changes in LCS outcomes correlated with changes to LCS navigation processes, technology, and the coronavirus disease 2019 pandemic.

This evaluation of a decade of robust LCS data within a community setting highlights the need for established national quality metrics that incentivize health systems to conduct ongoing program monitoring, evaluation, and adaptation to optimize screening benefits.