National Survey of Lung Cancer Screening Eligibility in United States Veterans

Abstract

Introduction

Lung cancer screening is underutilized, especially in rural areas where lung cancer mortality is high. Approximately 11.2% of the U.S. population over age 50 years meet the U.S. Preventive Services Task Force (USPSTF) 2021 lung cancer screening eligibility criteria; the proportion of eligible Veterans is unknown. This study evaluated the proportion of Veterans who are USPSTF-eligible and tested the hypothesis that more USPSTF 2021–eligible Veterans reside in rural versus nonrural areas.

Methods

Investigators cross-sectionally surveyed a national sample of Veterans aged 50 years and older January–November 2022. Oversampling ensured inclusion of minority groups and accounted for geographic variation in tobacco use. Analyses in 2023–2024 evaluated the proportion of USPSTF-eligible Veterans by year (2013 and 2021) and tested USPSTF-2021 eligibility by rural status (rural versus nonrural) using chi square tests. Weighting accounted for survey nonresponse and applied results to the whole Veteran population in a sensitivity analysis.

Results

Of 2,000 surveyed, 754 responded (37.7% response rate); most respondents were White (74.4%), male (92.6%), and resided in nonrural areas (66.0%). Proportions meeting USPSTF criteria were 35.5% (95% CI=31.6%, 39.6%) in 2021 and 27.8% (95% CI=24.3%, 31.7%) in 2013. The proportion of USPSTF 2021–eligible rural Veterans (41.2%; 95% CI=34.8%, 48.0%) was higher compared with nonrural (32.5%; 95% CI=27.7%, 37.7%), p=0.037. A sensitivity analysis found the proportion of Veterans USPSTF 2021 eligible in the whole population was 33.0%.

Conclusions

The proportion of Veterans USPSTF2021 eligible was nearly 3 times higher than the general U.S. population (11.2%), and a greater proportion of eligible Veterans resided in rural compared with nonrural areas. These findings are critical for policies aimed at fully implementing lung cancer screening at scale.