Lung Cancer Screening Uptake in Patients with Rheumatoid Arthritis in Community Settings

Individuals with rheumatoid arthritis (RA), particularly those with a history of smoking, are at increased risk for lung cancer. However, real-world data on the use of low-dose computed tomography (LDCT) screening for lung cancer in this population are lacking. Therefore, we assessed the rates, trends, and predictors of LDCT screening among patients with a smoking history and RA. A retrospective cohort study using the IQVIA PharMetrics Plus for Academics Closed Health Plan claims database was conducted. Patients with RA diagnosed between 2014 and 2023, aged 50 to 77 years, and with a history of smoking and no prior cancer or advanced respiratory illness were identified. LDCT screening was identified using Healthcare Common Procedure Coding System codes. Among 15,341 eligible patients, 997 (6.5%) received LDCT screening; the median time from RA diagnosis to the first LDCT claim was 452 days. In a sensitivity analysis of 12,301 patients with continuous insurance coverage during the 12 months after RA diagnosis, only 367 (3%) underwent LDCT within the first year after RA diagnosis. Demographic factors such as male sex [adjusted odds ratio (aOR), 1.24; P = 0.003], age 55 to 69 years (aOR, ∼1.90; P < 0.0001), and residence outside the West region (P < 0.0001) increased uptake. Clinical characteristics and healthcare utilization, such as chronic obstructive pulmonary disease (aOR, 2.85; P < 0.0001), more outpatient visits (aOR, 2.15-2.41; P < 0.001), and disease-modifying antirheumatic drug use (aOR, 1.27-1.52; P ≤ 0.001), also increased odds, whereas a greater comorbidity burden reduced screening (aOR, 0.79-0.39; P ≤ 0.006). In conclusion, LDCT rates in patients with RA remained low overall and varied according to demographic and clinical factors. Targeted efforts may be needed to improve screening uptake in this high-risk population.

This study is relevant to cancer prevention because lung cancer screening is an established strategy for reducing lung cancer mortality, yet many high-risk patients do not receive timely or consistent screening. Our study is groundwork for future efforts to improve early lung cancer detection and prevention in high-risk populations.