Geography, demographics remain obstacles in lung cancer screening

The geographic, economic and demographic diversity of the United States is an undeniable challenge in determining individuals’ access to healthcare. A recent study published in the Journal of the American College of Radiology (ACR)  assessed such access for lung cancer screening services by state and how that affects the economic and demographic makeup of an area.

Researchers from the University of Michigan examined this access by the number and distribution of screening facilities by state in the ACR's Lung Cancer Screening Registry (LCSR).

"Although some of the financial barriers to screening have been reduced, geographic access to services, including proximity of at-risk populations to screening facilities, represents a potential barrier," said lead author of the study Paniz Charkhchi, MD. "We aimed to assess the relationship between the availability of lung cancer screening facilities and the size of the at-risk population as well as state-level clinically relevant epidemiologic and demographic variables."

Researchers found that, by Nov. 18, 2016, 2,423 facilities participated in the LCSR with an average of 32 per state, or a median population normalized facility number of 15.7.

Florida has the largest number of LCSR-registered screening facilities (198) while the District of Columbia and Montana have the smallest (three) according to study. Charkhchi and her team also noted that in most states, facilities are clustered together, though they are dispersed in more rural states.

"Appropriately, the number of lung cancer screening facilities correlated with the estimated number of individuals eligible for screening by state; however, the frequency of screening facilities was not associated with lung cancer incidence and death rates, smoking prevalence or other state-level demographic variables," Charkhchi added. "There were no significant correlations between number of facilities and lung cancer outcomes, state demographic characteristics or physician supply and Medicare expenditure."

The study used a list of LCSR-participating lung cancer screening facilities from the American College of Radiology (ACR) to determine the availability of facilities in each state. Using Behavioral Risk Factor Surveillance System data, the number of facilities by state by the number of screening-eligible individuals was normalized by researchers.

"The availability of screening services correlates strongly with the number of screening-eligible individuals, for whom practice reimbursement is ensured, may suggest response to market forces and local demand," Charkhchi concluded. "Nonetheless, opportunity to align lung screening availability with relevant clinical variables, such as state-level lung cancer deaths, or other population risk factors, such as smoking prevalence, remains as a public health consideration."