Lung Cancer Screening Eligibility, Uptake, and Adherence in Puerto Rico, 2022

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Abstract Importance: Lung cancer screening (LCS) with yearly low-dose computed tomography reduces lung cancer mortality, but uptake remains low. Puerto Rico, a U.S. territory, faces significant barriers to LCS implementation, but data on LCS eligibility and use are limited. Objective: To estimate the number of individuals eligible for LCS in Puerto Rico and assess the prevalence of LCS use and up-to-date status compared to U.S. Hispanic and non-Hispanic populations. Design, Setting, and Participants: This cross-sectional study analyzed data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey. Adults eligible for LCS per 2021 U.S. Preventive Services Task Force guidelines (aged 50-80, ≥20 pack-year smoking history, current or recent smokers) from Puerto Rico and the U.S. were included. Exposures: Participants were categorized into three groups: Puerto Rico residents, U.S. Hispanic, and U.S. non-Hispanic populations. Main Outcomes and Measures: Self-reported receipt of initial LCS (ever had chest CT for screening) and being up-to-date with LCS (i.e. chest CT in the past year). Multivariable Poisson models estimated adjusted prevalence ratios (APRs) for LCS outcomes. Results: After population weighting, 94,955 individuals were eligible for LCS in Puerto Rico, compared to 12.8 million in the U.S., representing 7.9% and 12.7% of their respective populations. The prevalence of self-reported LCS use was 28.4% in Puerto Rico, 27.6% among U.S. Hispanics, and 31.5% among U.S. non-Hispanics. Being up-to-date with LCS was lower among Puerto Rico residents (9.8%) than in U.S. Hispanics (17.3%) and non-Hispanics (18.1%). Multivariable models showed Puerto Rico residents were less likely to be up-to-date with LCS compared to U.S. non-Hispanics (APR, 0.54; 95% CI 0.29-0.99). Conclusions and Relevance: Less than 10% of eligible individuals in Puerto Rico self-reported being up-to-date with LCS, almost half as likely as eligible individuals in the US, highlighting significant gaps in care. Expanding high-quality LCS in Puerto Rico is critical to reducing lung cancer mortality and providing equitable lung cancer care.

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