National lung cancer screening utilization trends in the veterans health administration

Jennifer A. Lewis, Lauren R. Samuels, Jason Denton, Gretchen C. Edwards, Michael E. Matheny, Amelia Maiga, Christopher G. Slatore, Eric Grogan, Jane Kim, Robert H. Sherrier, Robert S. Dittus, Pierre P. Massion, Laura Keohane, Sayeh Nikpay, Christianne L. Roumie

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Many Veterans are high risk for lung cancer. Low-dose computed tomography (LDCT) is an effective strategy for lung cancer early detection in a high-risk population. Our objective was to describe and compare annual and geographic utilization trends for LDCT screening in the Veteran's Health Administration (VHA). Methods: A national retrospective cohort of screened Veterans from January 1, 2011 to May 31, 2018 was used to calculate annual and regional rates of initial LDCT utilization per 1000 eligible Veterans. We identified Veterans with a first LDCT exam using common procedure terminology codes G0297 or 71250 and described as "lung cancer screening," "screening," or "LCS." The number of screen-eligible Veterans per year was calculated as unique Veterans aged 55 to 80 years seen at a Veterans Affairs medical center (VAMC) in that year, multiplied by 32% (estimated proportion with eligible smoking history). We present 95% confidence intervals (CI) for rates. Results: Screened Veterans had a mean age of 66.1 years (standard deviation [SD] = 5.6); 95.5% male; 77.4% Caucasian. There were 119 300 LDCT exams, of which 80 819 (67.7%) were initial. Nationally, initial screens increased from 0 (95% CI = 0.00 to 0.00) in 2011 to 29.6 (95% CI = 29.26 to 29.88) scans per 1000 eligible Veterans in 2018 (Ptrend<.001). Initial screens increased over time within all geographic regions, most prominently in northeastern and Florida VAMCs. Conclusion: VHA LDCT utilization increased from 2011 to 2018. However, overall utilization remained low. Future interventions are needed to increase lung cancer screening utilization among eligible Veterans.

Original languageEnglish (US)
Article numberpkaa053
JournalJNCI Cancer Spectrum
Volume4
Issue number5
DOIs
StatePublished - 2021
Externally publishedYes

Bibliographical note

Funding Information:
Disclosures: Dr Slatore is supported by resources from the VA Portland Health Care System in Portland, Oregon. He is the medical co-director of the lung cancer screening programs at the institution where he is employed but does not receive additional compensation for this role. All other authors have no disclosures.

Funding Information:
This work was supported by the US Department of Veterans Affairs (VA) Office of Rural Health (ORH). Visit www.rural-health.va.gov to learn more. This study was also supported in part by the Vanderbilt CTSA grant UL1 TR000445 from the National Center for Advancing Translational Sciences, National Institutes of Health and the Veterans Affairs Office of Academic Affiliations.

Publisher Copyright:
© 2020 Oxford University Press. All rights reserved.

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