Health Beliefs and Adherence to Lung Cancer Screening in a Diverse Safety-Net Population

Lung cancer screening (LCS) with low-dose CT (LDCT) remains markedly underutilized. Prior studies suggest that perceptions regarding LCS may influence intention to undergo LDCT; however, little is known about these beliefs and behaviors in vulnerable populations. We examined LCS-related health beliefs and LDCT completion in an urban safety-net health care system.

We surveyed English- and Spanish-speaking individuals between February 2017 and February 2019 who had been scheduled for, but had not yet undergone, an initial LDCT. Survey items were adapted from validated measures, including the Lung Cancer Screening Health Belief Scales and the Lerman Breast Cancer Worry Scales, to assess LCS-related beliefs and lung cancer-related worry. We examined associations between these factors and LDCT completion using 2-sample t tests and chi-square tests.

Among 447 eligible individuals, 411 participated in the survey (71% from racial/ethnic minoritized groups), of whom 339 (82%) completed the initial LDCT. Almost half believed that they were at risk for lung cancer in their lifetime, and >90% believed that LCS would help find lung cancer early. Higher self-efficacy scores and lower perceived barriers scores were associated with LDCT completion (P=.002 and P=.004, respectively). Perceived risk and benefit scores were not associated with LDCT completion. Individuals who did not complete the first LDCT were more likely to note fear of lung problems (33% vs 18%; P<.001), stigma related to lung cancer (33% vs 17%; P=.008), and worry affecting mood (77% vs 64%; P=.02).

In a diverse, real-world LCS population, most patients believed that LCS facilitates early detection of lung cancer; however, approximately 20% did not complete the initial LDCT. Perceived fear, stigma, and negative emotional responses to a potential lung cancer diagnosis were associated with lower LDCT completion rates. These findings offer insight into potentially modifiable factors and future interventions to improve LCS uptake among eligible individuals.