Objective:

To evaluate real-world diagnostic follow-up after positive lung cancer screening results among Medicare beneficiaries.

Approach:

• Study Design: Linked data from the American College of Radiology Lung Cancer Screening Registry and Medicare claims files were used to assess follow-up from 2015 to 2022.
• Cohort: The study included 64,555 adults aged 65 years or older with a first positive screening examination.
• Follow-up Classification: Follow-up was classified as guideline-concordant, less intensive, or more intensive based on Lung-RADS recommendations.
• Statistical Analysis: Multivariable logistic regression models identified factors associated with nonconcordant follow-up.

Key Findings:

• 60% of Medicare beneficiaries with a positive screening result received guideline-concordant follow-up within 1 year.
• 32% received less intensive care than recommended, and 8% received more intensive care.
• Concordance increased with higher radiographic suspicion, from 49% for category 3 to 80% for category 4X.
• 12% of adults received a lung cancer diagnosis within 1 year, with incidence increasing from 2% in category 3 to 59% in category 4X.
• Invasive procedures were performed in 16% of all adults, with 40% of bronchoscopies occurring in adults without cancer.

Interpretation:

Limitations:

• The cohort was restricted to fee-for-service Medicare beneficiaries, excluding those in Medicare Advantage plans.
• The study could not determine if procedures were specifically for lung cancer follow-up.
• Limited data on institutional characteristics and patient socioeconomic factors.
• Did not assess the impact of follow-up intensity on cancer stage at diagnosis or mortality.

Conclusion:

Sources:

• Annals of Internal Medicine