Impact of Current Smoking Status on Uptake of Lung Cancer Screening Referral in a Cohort of Racially Diverse Patients

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Conference Proceeding

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SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: In 2013, the US Preventive Services Task Force (USPSTF) recommended lung cancer screening by low-dose computed tomography (LDCT) for individuals ages 55-80 with a smoking history of 30 pack-years or more. Factors that affect uptake of screening recommendations are of utmost importance, particularly in marginalized groups, in order to prevent the disparity typically seen with new screening regimens. In this study, we assess factors that may affect the uptake of a referral to lung cancer screening at Henry Ford Health System. Particularly of interest were race and smoking status at the time of the first screening recommendation. METHODS: Using a cohort of patients referred for lung cancer screening between March 1, 2015 and February 28, 2018 (N=4,097), we used multivariable logistic regression to determine whether race or smoking status were associated with completion of an initial lung screening exam. Data were captured using the health system’s electronic medical record. RESULTS: Of all patients referred for screening, 932 (22.7%) were black and 2,747 (67.0%) were white. Current smokers represented 60.7%, 57.3%, and 70.2% of all, white, and black patients, respectively. Overall, 2,791 (68.1%) patients completed an initial LDCT screen. Of these, 614 (22.0%) were black and 1,902 (68.1%) were white. In multivariable analyses, race was not associated with completion of LDCT screen. Former smokers were more likely to complete a screening exam than current smokers (aOR 1.170, 95% CI 1.01-1.36). However, this finding differed by racial group; among whites, the adjusted odds ratio for lung cancer screening uptake comparing former smokers to current smokers was 1.32 (95% CI 1.10-1.59). Among blacks, smoking status was not significantly associated with screening (aOR 0.84 [95% CI 0.60-1.16]). CONCLUSIONS: These findings have implications for promoting uptake of lung screening among diverse patient populations. CLINICAL IMPLICATIONS: Racially diverse patient groups may require tailored shared decision making in lung cancer screening.





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