LAUSR

BACKGROUND Screening current and former heavy smokers aged 55-80 years for lung cancer with low dose chest CT has been recommended by the USPSTF since 2013. Although the number of screening facilities in the US has increased, screening uptake has been slow. To better understand the slow screening uptake, we evaluated geographic access to screening facilities nationwide. METHODS Screening facilities were defined as American College of Radiology Lung Cancer Screening Registry (ACR-LCSR) facilities. Analysis was performed at different geographic levels using a road network to calculate travel distances for the recommended age groups. Full access to screening was defined as all the 55-79-year-old population being within 40 miles of an ACR-LCSR facility; no access as lack of access by the entire target population; and partial access expressed in intervening quartiles. A geospatial approach was then used to integrate accessibility with smoking prevalence and lung cancer mortality rates to visually identify potential focus areas. RESULTS Screening facilities addresses were geocoded to identify 3,592 unique locations. Analysis of census tracts and aggregation to counties revealed that among 3,142 counties, adults 55-79 have full access to an LCSR screening facility in 1,988 (63%) counties, partial access in 587 (19%) counties and no access in 567 (18%) counties. Overall, less than 6% of the 55-79 age group does not have access to registry screening facilities. Variation in screening facility access was noted across the US, between states, and within some states. CONCLUSION It is recommended to calculate accessibility using sub-county geographies and examine variation regionally and within states. A foundation geographic accessibility layer can be integrated with other variables to identify geographic disparities in access to screening and focus areas for interventions. Identifying areas of greatest need can inform state and local officials and healthcare organizations when planning and implementing lung cancer screening programs.