Screening
Impact of the 2021 us preventive services task force guidelines update on lung cancer screening adherence: disparities in marginalized and underserved communities LaShae D. Rolle* LaShae Rolle Coral Olazagasti Gilberto Lopes Estelamari Rodriguez Tracy E. Crane
Background: In 2021, the us preventive services task force updated lung cancer screening guidelines, expanding eligibility criteria to include adults aged 50 to 80 years with a smoking history of ≥20 pack-years, compared to the previous criteria of 55 to 80 years with ≥30 pack-years. This expansion aimed to increase access to early detection by including younger individuals and those with a lighter smoking history. Hence, this study evaluated the impact of these changes on screening uptake, with a focus on disparities among marginalized and underserved populations.
Methods: Data from the behavioral risk factor surveillance system for 2019-2020 (pre-guideline changes) and 2022-2023 (post-guideline changes) were analyzed. Multivariable logistic regression models estimated aor for lung cancer screening uptake and accounted for the behavioral risk factor surveillance system’ complex survey design. Key predictors included sex, race, income, education, urban/rural status, health insurance, having a health care provider, and being up to date on lung cancer screening (yes/no).
Results: Lung cancer screening uptake increased significantly following the guideline update. The odds of screening were 4.66 times higher post-guideline changes compared to pre-guideline changes (aor = 4.66, 95% ci: 4.01-5.42, p < 0.0001). Lack of health insurance coverage (aor = 0.28, 95% ci: 0.19-0.42, p < 0.0001), being a rural resident (aor = 0.73, 95% ci: 0.61-0.88, p < 0.001) not having a health provider (aor = 0.71, 95% ci: 0.51-1.00, p < 0.05) decreased odds of screening compared to their counterparts.
Discussion: The updated us preventive services task force guidelines dramatically increased screening uptake but highlighted disparities among disadvantaged and underserved populations such as those living in rural areas, uninsured, and without a health provider. Targeted interventions addressing geographic and structural barriers are essential to ensure equitable access to screening.
