Patients without PCPs struggle to access lung cancer screening, despite eligibility
Many eligible patients are missing out on potentially life-saving lung cancer screenings due to not having primary care providers.
A new paper in JAMA details the important role PCPs play in getting patients to complete lung cancer screening—an exam that is already significantly underutilized. Researchers found that up to 60% of hospitals are unable to schedule patients for the scan because they do not have imaging orders from a PCP, despite patients being eligible based on guidelines from the U.S. Preventive Services Task Force (USPSTF).
“The need for primary care involvement could pose an important barrier to lung cancer screening, as 100 million people in the US currently lack access to a primary care practitioner. While primary care is not a specific requirement for lung cancer screening reimbursement, primary care practitioners can perform several of the required steps,” corresponding author Daniel J. Boffa, MD, from the Division of Thoracic Surgery at Yale School of Medicine, and colleagues explained.
With up to one-third of the U.S. population not having a PCP, researchers sought to assess how the lack this provider affects patients’ ability to complete lung cancer screening. To do this, the team directly contacted 527 hospitals to attempt to begin the process of being scheduled for the exam.
Less than 10% of the hospitals were able to initiate any step of the screening process for patients. Most often (60.2% of the time), this was because the hospital did not have an imaging order from a PCP.
Though having a physician’s order undoubtedly simplifies the process of being screened, that isn’t the only reason having a relationship with the ordering physician is crucial. The authors estimate that up to 34% of patients will have incidental findings discovered during their exam, many of which could require additional follow-up visits and counseling. Patients without an ordering provider would be required to self-manage the next steps of their care.
Although not having a PCP alone cannot fully explain the lackluster lung cancer screening rates in the U.S., it certainly presents a significant barrier for patients, the authors noted.
“The primary care issue is clearly not the only answer, as there are likely millions of screen-eligible people with an established primary care practitioner who are not being screened,” the team wrote. “However, efforts to motivate the public to pursue lung cancer screening must be met with equal efforts to provide pathways for them to connect, particularly among the medically disenfranchised.”
Previous estimates from the American Lung Association indicate that less than 6% of those eligible to be screened for lung cancer undergo the exam.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.