--- title: "LDCT lung CA screening: low uptake. | Sutter Health" description: "Lung CA screening may be more effective if they focus on accurate documentation of smoking hx and target former smokers who don't see their own PCP." url: "https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. LDCT lung CA screening: low uptake. # New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low. Li J, Chung S, Wei EK, & Luft HS. _BMC Health Serv Res. 18(1):525. doi: 10.1186/s12913-018-3338-9._ 2018-07-05 ## Abstract BACKGROUND: In 2013, the US Preventive Services Task Force (USPSTF) issued recommendations for low-dose computed tomography for lung cancer screening (LDCT-LCS), but there continues to be a dearth of information on the adoption of LDCT-LCS in healthcare systems. Using a multilevel perspective, our study aims to assess referrals for LDCT-LCS and identify facilitators and barriers to adoption following recent policy changes. METHODS: A retrospective analysis of electronic medical record data from patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a large healthcare system in California during 2010-2016 (1,572,538 patient years). Trends in documentation of smoking history, number of eligible patients, and lung cancer screening orders were assessed. Using Hierarchical Generalized Linear Models, we also evaluated provider-level and patient-level factors associated with lung cancer screening orders among 970 primary care providers and 12,801 eligible patients according to USPSTF guidelines between January 1st, 2014 and December 31st, 2016. RESULTS: Documentation of smoking history to determine eligibility (59.2% in 2010 to 77.8% in 2016) and LDCT-LCS orders (0% in 2010 to 7.3% in 2016) have increased since USPSTF guidelines. Patient factors associated with increased likelihood of lung cancer screening orders include: younger patient age (78-80 vs. 55-64 years old: OR, 0.4; 95% CI, 0.3-0.7), Asian race (vs. Non-Hispanic White: OR, 1.6; 95% CI, 1.1-2.4), reported current smoking (vs. former smoker: OR, 1.7; 95% CI, 1.4-2.0), no severe comorbidity (severe vs. no major comorbidity: OR = 0.2, 95% CI = 0.1-0.3; moderate vs. no major comorbidity: OR = 0.5; 95% CI = 0.4-0.7), and making a visit to own primary care provider (vs. other primary care providers: OR, 2.4; 95% CI, 1.7-3.4). Appropriate referral for lung cancer screening varies considerably across primary care providers. Provider factors include being a female physician (vs. male: OR, 1.6; 95% CI, 1.1-2.3) and receiving medical training in the US (foreign vs. US medical school graduates: OR = 0.4, 95% CI = 0.3-0.7). CONCLUSIONS: Future interventions to improve lung cancer screening may be more effective if they focus on accurate documentation of smoking history and target former smokers who do not regularly see their own primary care providers. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/29976189) ![Jiang Li, Ph.D., MPH](https://dyn.mktgcdn.com/p/H4OFJqNxBzDqkSWaIqDBiZgqIsHNsHLWdLuMd9IlNx0/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Jiang Li, Ph.D., MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/jiang-li-phd-mph-1049681008) ## Research topics - [All Cancer](https://www.sutterhealth.org/research-search-results?query=%22%5C%22All+Cancer%5C%22%22) - [Lung Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Lung+Diseases%5C%22%22) - [Medical Informatics](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Medical+Informatics%5C%22%22) - [Smoking](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Smoking%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [Provider perspectives on advance care planning documentation in the electronic health record.](https://www.sutterhealth.org/research/publications/providers-on-advance-care-plans-ehr-1055312324) Dillon E, Chuang J, Gupta A, Tapper S, Lai S, Yu P, Ritchie C, Tai-Seale M. Am J Hosp Palliat Care. 1049909117693578. doi: 10.1177/1049909117693578. \[Epub ahead of print\] 2017 Jan 01 - Publication ### [Precision lifestyle medicine: a new frontier in the science of behavior change and population health.](https://www.sutterhealth.org/research/publications/precision-lifestyle-medicine-1055312346) Ma J, Rosas LG, Lv N. Am J Prev Med. pii: S0749-3797(15)00638-8. doi: 10.1016/j.amepre.2015.09.035. \[Epub ahead of print\] 2015 Dec 01 - Publication ### [Competing risk bias to explain the inverse relationship between smoking and malignant melanoma.](https://www.sutterhealth.org/research/publications/competing-risk-bias-relationship-smoking-melanoma-1055312807) Thompson CA, Zhang ZF, Arah OA. Eur J Epidemiol. 28(7):557-67. doi: 10.1007/s10654-013-9812-0. Epub 2013 May 23. 2014 Jul 01 - Publication ### [Smoking and lung cancer: current trends in Austria.](https://www.sutterhealth.org/research/publications/smoking-lung-cancer-trends-in-austria-1055312823) Thompson CA, Waldhör T, Schernhammer ES, Hackl M, Vutuc C, Haidinger G. Wien Klin Wochenschr. 124(15-16):493-9. Epub 2012 Jul 20. 2012 Aug 01 - Publication ### [A randomized trial of parental behavioral counseling and cotinine feedback for Lowering Environmental Tobacco Smoke exposure of children with asthma: results of the LET'S Manage Asthma trial](https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576) Wilson SR, Farber HJ, Knowles SB, Lavori PW Chest. 139(3):581-90. doi: 10.1378/chest.10-0772. Epub 2010 Sep 23. 2010 Sep 23 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"LDCT lung CA screening: low uptake."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362#medicalscholarlyarticle","name":"New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low.","headline":"LDCT lung CA screening: low uptake.","abstract":"BACKGROUND: In 2013, the US Preventive Services Task Force (USPSTF) issued recommendations for low-dose computed tomography for lung cancer screening (LDCT-LCS), but there continues to be a dearth of information on the adoption of LDCT-LCS in healthcare systems. Using a multilevel perspective, our study aims to assess referrals for LDCT-LCS and identify facilitators and barriers to adoption following recent policy changes. METHODS: A retrospective analysis of electronic medical record data from patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a large healthcare system in California during 2010-2016 (1,572,538 patient years). Trends in documentation of smoking history, number of eligible patients, and lung cancer screening orders were assessed. Using Hierarchical Generalized Linear Models, we also evaluated provider-level and patient-level factors associated with lung cancer screening orders among 970 primary care providers and 12,801 eligible patients according to USPSTF guidelines between January 1st, 2014 and December 31st, 2016. RESULTS: Documentation of smoking history to determine eligibility (59.2% in 2010 to 77.8% in 2016) and LDCT-LCS orders (0% in 2010 to 7.3% in 2016) have increased since USPSTF guidelines. Patient factors associated with increased likelihood of lung cancer screening orders include: younger patient age (78-80 vs. 55-64 years old: OR, 0.4; 95% CI, 0.3-0.7), Asian race (vs. Non-Hispanic White: OR, 1.6; 95% CI, 1.1-2.4), reported current smoking (vs. former smoker: OR, 1.7; 95% CI, 1.4-2.0), no severe comorbidity (severe vs. no major comorbidity: OR = 0.2, 95% CI = 0.1-0.3; moderate vs. no major comorbidity: OR = 0.5; 95% CI = 0.4-0.7), and making a visit to own primary care provider (vs. other primary care providers: OR, 2.4; 95% CI, 1.7-3.4). Appropriate referral for lung cancer screening varies considerably across primary care providers. Provider factors include being a female physician (vs. male: OR, 1.6; 95% CI, 1.1-2.3) and receiving medical training in the US (foreign vs. US medical school graduates: OR = 0.4, 95% CI = 0.3-0.7). CONCLUSIONS: Future interventions to improve lung cancer screening may be more effective if they focus on accurate documentation of smoking history and target former smokers who do not regularly see their own primary care providers.","description":"Lung CA screening may be more effective if they focus on accurate documentation of smoking hx and target former smokers who don't see their own PCP.","keywords":["All Cancer","Lung Diseases","Medical Informatics","Smoking"],"datePublished":"2018-07-05","url":"https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"29976189"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.1186/s12913-018-3338-9"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/29976189/","https://doi.org/10.1186/s12913-018-3338-9"],"isPartOf":{"@type":"Periodical","name":"BMC Health Serv Res"},"author":[{"@type":"Person","@id":"https://www.sutterhealth.org/research/investigators/jiang-li-phd-mph-1049681008","name":"Li J","url":"https://www.sutterhealth.org/research/investigators/jiang-li-phd-mph-1049681008"},{"@type":"Person","name":"Chung S"},{"@type":"Person","name":"Wei EK"},{"@type":"Person","name":"Luft HS"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"All Cancer","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22All+Cancer%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Lung Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Lung+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Medical Informatics","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Medical+Informatics%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Smoking","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Smoking%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362#breadcrumblist"}}} ```