Predictors and latent class associations with lung cancer screening intentions

Less than one in five eligible adults has received lung cancer screening (LCS) with low dose computed tomography in the U.S. We aimed to determine factors associated with intentions to undergo LCS.

Cross-sectional survey of LCS-eligible English and Spanish speaking adults in two primary care systems in Massachusetts and Oklahoma from 02/2023-05/2024. Surveys assessed smoking, lung cancer and LCS history, attitudes, beliefs, and psychological factors. Associations between these factors and screening intentions were assessed with multivariable logistic regression using bootstrap sampling to select model variables, and latent class analysis plus chi-square tests to measure associations between classes and intentions.

Of 292 LCS eligible survey respondents, most were currently smoking (n = 174, 59.6%), some had previously undergone LCS (n = 115, 39.5%), and 29.5% (n = 86) were 'extremely likely' to screen in the next 12 months. In regression models, having a healthcare provider recommend LCS (odds ratio [OR]: 4.22, 95% confidence interval (CL) 2.40-7.44), being 'somewhat' or 'extremely worried' about getting lung cancer (OR 2.45, 95%CI 1.40-4.32), and speaking English at home (OR 3.54, 95% CI 1.74-7.17) were associated with intention to screen. Four latent classes emerged that varied by age, race, ethnicity, smoking status, screening self-efficacy, perceived risks, and cancer worry. Classes were significantly associated with screening intentions (p < .0001).

Factors associated with LCS intentions highlight opportunities to expand screening. Attending to content for Hispanic adults, increasing discussions of LCS by health care providers, and tailoring communications to incorporate cancer worry could increase use of this life-saving intervention.