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Lung Cancer Screening Centralization Is Associated With Improved Screening Uptake: The Veterans Healthcare
Lawrence N Benjamin1, Eduardo R Núñez2, Lillian Chen3
1Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Chest
|July 8, 2026
Summary
Centralized lung cancer screening (LCS) programs significantly increase patient uptake compared to decentralized models. Hybrid and fully-centralized approaches show benefits, but tailored strategies are needed to address persistent screening disparities.
Area of Science:
- Public Health
- Health Services Research
- Oncology
Background:
- Lung cancer screening (LCS) is underutilized despite being the leading cause of cancer mortality.
- Centralized LCS programs, managed by dedicated teams, may improve uptake compared to decentralized, provider-led models.
- Variations in centralization (hybrid vs. fully-centralized) exist, with unclear differential effectiveness on patient enrollment.
Purpose of the Study:
- To investigate the association between the level of LCS program centralization and LCS uptake.
- To compare the effectiveness of decentralized, hybrid, and fully-centralized LCS models in increasing screening rates.
Main Methods:
- Retrospective, longitudinal nationwide cohort study using Veterans Health Administration data (2015-2021).
- Included Veterans aged 55-80 years undergoing screening.
- Employed a difference-in-differences Poisson model to assess quarterly LCS uptake rates across facility program types (decentralized, hybrid, fully-centralized).
Main Results:
- Overall LCS uptake was lower in Hispanic, female, older (≥65 years), and rural Veterans.
- Compared to decentralized programs, hybrid (IRR=1.47) and fully-centralized (IRR=1.75) LCS programs showed significantly increased uptake.
- Hybrid models improved uptake for rural Veterans; fully-centralized models benefited Veterans in disadvantaged regions and those with higher out-of-pocket costs, though recruited fewer rural Veterans.
Conclusions:
- Both hybrid and fully-centralized LCS program models are associated with improved screening uptake.
- Specific program centralization models offer advantages for particular veteran subgroups.
- Persistent disparities underscore the necessity for tailored strategies to enhance LCS accessibility and equity.
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