LAUSR

Use of CT and Chest Radiography for Lung Cancer Screening Before and After Publication of Screening Guidelines: Intended and Unintended Uptake The National Lung Screening Trial (NLST) released its main findings in 2011,1 concluding that the use of low-dose computed tomography (CT) to screen for lung cancer reduced l u ng c a n c e r d e at h s by 2 0 % c o m p a re d w it h c h e s t radiography.1,2 The subsequent publication of new lung cancer screening (LCS) guidelines may raise the public’s awareness of the clinical application of lowdose CT in screening,3,4 leading to increased demand for screening not only by individuals who meet the eligibility criteria recommended for LCS but also by those who do not. The present study documents early experience of LCS in terms of both intended and unintended uptake of low-dose CT at the population level. Methods | We used data from the 2010 and 2015 National Health Interview Survey (NHIS) Cancer Control Module (CCM) (https: //healthcaredelivery.cancer.gov/nhis/) linked to the core questionnaire and limited our study cohort to individuals who were 40 years or older. Using smoking status and history from the CCM, we classified individuals into high-risk smokers (30 pack-years of smoking history, current smokers or those who quit smoking within the last 15 years), low-risk smokers (current or former smokers who did not meet the criteria of high-risk smokers), and never-smokers. Per the age eligibility criteria in the NLST, we defined LCS-eligible individuals as high-risk smokers aged 55 to 74 years. We identified LCS with CT using the survey question “Were any of the CAT scans of your chest area done to check for lung cancer, rather than for some other reason?” A similar question was used to identify LCS with chest radiography. Weighted analyses that accounted for the multistage survey design of the NHIS were performed to compare the utilization of CT in 2010 and 2015. This study was exempted from review and participant written informed Editorial page 311