Baseline prevalence of lung cancer screening and associated factors among women in breast cancer screening clinics prior to the Pink & Pearl program: A retrospective analysis of electronic health records
This retrospective analysis of nearly 10,000 women at breast cancer screening clinics reveals that while baseline lung cancer screening uptake (33.1%) exceeded the national average, it was significantly lower among non-Hispanic Black women and strongly associated with the completeness of smoking history documentation, current smoking status, and tobacco cessation medication use.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Lung cancer remains the most deadly form of cancer in the United States, claiming more lives than any other. While treatments have improved for many diseases, lung cancer often goes undetected until it has spread too far to be easily treated. The key to changing this outcome is finding the disease early, while it is still small and localized. For decades, doctors have known that a specific type of low-radiation scan, called a low-dose computed tomography, can spot these early signs in people at high risk. However, despite clear medical guidelines recommending these scans for millions of smokers and former smokers, very few people actually get them. National data suggests that only about 18 percent of eligible individuals undergo this screening. This gap is particularly noticeable among women, who often visit doctors regularly for breast cancer checks but may still miss the opportunity to be screened for lung cancer.
Researchers in St. Louis decided to investigate why this gap exists and who is getting screened within a large hospital system. They focused on women who were already visiting clinics for breast cancer screening, looking back at six years of medical records to see how many of them had also received lung cancer scans. The team examined nearly 9,700 women between the ages of 50 and 80 who had a history of smoking. They wanted to understand what factors made it more or less likely for a woman to get this life-saving test. By looking at real-world data rather than asking patients what they remembered, the researchers could see the actual patterns of care, including how doctors documented smoking habits and whether patients were taking medication to help them quit.
The study revealed that within this specific group of women, the screening rate was higher than the national average, with about one-third of the women having received at least one lung cancer scan. However, the researchers found that the most powerful factor predicting whether a woman got screened was not her age or her race, but simply whether her medical record clearly stated how much she had smoked. Women whose records included a specific measurement of their smoking history, known as pack-years, were nearly three times more likely to have been screened than those whose records lacked this detail. This finding highlights a significant barrier: if a doctor does not write down the full smoking history, the system often fails to flag the patient as eligible for the scan.
Beyond the documentation itself, the study showed that women who were currently using medication to help them quit smoking were also much more likely to receive lung cancer screening. This suggests that the moment a patient engages with a treatment plan for tobacco use creates a crucial window of opportunity for doctors to recommend the scan. Similarly, women who were still smoking at the time of their visit were more likely to be screened than those who had already quit, perhaps because current smokers are more visibly identified as high-risk during a visit. The researchers also noted that women who were non-Hispanic Black had slightly lower odds of receiving the screening compared to non-Hispanic White women, even after accounting for other factors like income and insurance. While this difference was small in the overall group, it persisted in the data, pointing to a need for more targeted efforts to ensure equitable care.
The analysis also looked at specific groups of women who met the strictest criteria for screening, such as those who had smoked heavily for many years. In these smaller groups, the racial gap in screening rates became less clear, though the numbers were too small to draw firm conclusions. What remained consistent across all groups was the importance of having a complete medical record. The study found that for a large portion of the women, the necessary details about their smoking history were missing entirely. This lack of information acts as a hidden wall, preventing many eligible women from being identified and referred for the scan they need.
These findings establish a clear baseline for a new initiative called the Pink & Pearl program, which aims to combine breast and lung cancer screening in the same location. The researchers hope that by placing these services together and ensuring that smoking histories are carefully recorded during breast cancer visits, they can close the gap for women who are already engaged in preventive care. The study does not claim to have solved the problem of low screening rates, but it has pinpointed exactly where the system is failing: in the documentation of smoking history and the engagement of patients with tobacco cessation support. By focusing on these concrete, actionable steps, the medical community can work toward ensuring that more women receive the early detection that could save their lives.
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