A national analysis revealed that adults eligible for lung cancer screening have markedly higher rates of breast and colorectal cancer screenings compared with lung cancer screenings, suggesting opportunities for targeted interventions.

In the research letter, published in JAMA, investigators from Massachusetts General Hospital analyzed 2022 data from the U.S. Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System (BRFSS) to evaluate preventive service use among U.S. adults eligible for lung cancer screening (LCS) on the basis of 2021 U.S. Preventive Services Task Force (USPSTF) criteria.

Among 212,393 BRFSS participants aged 50 to 79 years who met study inclusion criteria, 28,483 of them (weighted population = 13.2 million) were eligible for LCS.

Two dual-eligibility cohorts were identified:

• LCS/Breast Cancer Screening (BCS) cohort: 11,147 participants (weighted population = 4.9 million)
• LCS/Colorectal Cancer Screening (CCS) cohort: 24,172 participants (weighted population, 11.2 million).

In the LCS/BCS cohort, 65.0% (95% confidence interval [CI] = 63.1%–66.8%) underwent BCS, whereas just 17.0% (95% CI = 15.6%–18.3%) of them underwent LCS. In the LCS/CCS cohort, 64.7% (95% CI = 63.4%–65.9%) received CCS, while just 17.5% (95% CI = 16.6%–18.5%) of them underwent LCS.

Among LCS-eligible patients who had never undergone LCS, 60.2% (95% CI = 58.0%–62.3%) received BCS and 58.7% (95% CI = 57.2%–60.2%) received CCS.

“Many [patients] eligible for LCS are accessible to outreach and receptive to receiving preventive health care services,” the study authors wrote. The findings underscored the need for interventions to increase awareness about LCS and reduce barriers—including challenges in assessing eligibility (as a result of age and smoking history criteria) and limited access to LCS clinics.

Across nearly all sociodemographic subgroups, use of BCS and CCS was at least three times higher compared with LCS. Screening rates for BCS and CCS were also lower among participants eligible for LCS compared with among those ineligible, which the study authors suggested “may reflect a greater burden of barriers to accessing preventive health care in the LCS-eligible population.”

LCS for adults with a smoking history has been recommended by the USPSTF since 2013 and has the potential to save tens of thousands of lives annually. Despite this, adoption remains low, with just 18% of eligible patients undergoing screening in 2022.

The investigators highlighted a 2024 study demonstrating that an electronic health record–integrated intervention substantially increased LCS rates in one health care system, suggesting that screening uptake could improve with targeted system-level efforts.

The study relied on self-reported data on screening, which may have been subject to measurement bias. Additionally, the analysis didn't capture specific barriers that may have prevented patients from undergoing LCS.

This study was supported by a grant from the Agency for Healthcare Research and Quality (R18 HS029430). Author disclosures are available in the original research letter.