Introduction

Lung cancer screening has not been implemented widely, particularly in vulnerable populations. We sought to implement CT-based screening in a safety net system in Central Texas, aiming for equitable uptake. 

Methods

Using USPSTF criteria, high-risk patients ages 50-80 who were current smokers or had quit within 15 years and had >= 20 pack-years of exposure were eligible. Potentially eligible patients were identified through mailed outreach to age-eligible current and former smokers and through direct referrals within the system. A bilingual social work-trained navigator assessed eligibility, provided shared decision-making on screening benefits and downsides, helped patients access screening and follow-up, and offered intensive smoking cessation to current smokers. To assess equity, we compared LDCT completion rates across demographic groups. 

Results

Outreach materials were mailed to 6,770 patients and 483 patients responded via mail, phone, or text. Of these 483 patients, 186 (38.5%) participated in shared decision-making (SDM). Additionally, 311 patients were referred internally and 214 (68.8%) engaged in the SDM visit. Of the 400 total patients who completed the SDM process between November 2020 and September 2022, 392 (98.0%) indicated that they wanted to be screened.

Of those 392, mean age was 61.2 and 38% were female. The population was diverse: 35% identified as Latino and 20% as African-American; only 10% had private insurance, 29%  had Medicare or Medicaid, 47% were covered through the county medical assistance program, and 13.6% were uninsured; and 72% of participants were current smokers.

Overall, 324 of 392 (83%) patients completed CT screening. There were no statistically significant differences in completion by age, race/ethnicity, or insurance status. Median time from shared decision making to CT completion was 26.5 days (IQR 15-55 days).

Conclusion

We successfully implemented lung cancer screening in a vulnerable population. We are now working to disseminate this model in Texas and beyond.