A100-03 Lung Cancer Screening in the Veterans Health Administration, 2015-2025

Abstract Rationale Lung cancer screening (LCS) is underutilized. The Veterans Health Administration (VA) is a national pioneer in LCS. Guidelines recommend prioritizing screening among those in good health, as patients with advanced comorbidities or limited life expectancy benefit less. It is unclear whether LCS in the VA is being appropriately targeted to those in good health. Methods We constructed a cohort of LCS-eligible VA primary care patients who entered during 1/1/2015-9/30/2023 who were deemed healthy enough for LCS by their provider as documented in the LCS clinical reminder. We excluded patients in hospice/palliative care or with prior lung cancer. LCS was measured through 5/13/2025 using a validated method to exclude diagnostic tests. At LCS eligibility assessment, we captured sociodemographics and health metrics: 1) chronic obstructive pulmonary disease (COPD) with hypoxia, a condition which is unfavorable to LCS per the American College of Chest Physicians, 2) life expectancy, and 3) Care Assessment Needs (CAN) score which represents 1-year predicted mortality and is integrated into VA clinical dashboards. Multivariable logistic regression was used to examine screening uptake adjusted for pre-specified sociodemographic characteristics and by study cohort entry year (pre-pandemic, 2015-2019; pandemic, 2020-2021; pandemic recovery, 2022-2023). Results Of 171,686 patients who met cohort criteria, mean age was 65.6 years, 93% were male, 78% self-identified as white, and mean tobacco cigarette pack-years was 46.0. LCS uptake was 40.8% (95% CI: 40.6-41.0) over median follow-up of 2.3 years (IQR: 1.8-3.1) and increased over the study timeframe (Figure). LCS was less common among patients who were female (adjusted odds ratio (aOR) 0.95, 95% CI: 0.91-0.98), unmarried (aOR 0.93, 0.91-0.95), Black (0.80, 0.78-0.83), or who resided in rural areas (0.73, 0.72-0.75). Patients with advanced COPD or limited life expectancy were more likely to be screened than those without these conditions during 2015-2019; over time, screening declined among these groups but was still common with screening uptake of 37% and 38%, respectively. Patients with higher predicted mortality on a metric integrated into clinician-facing dashboards (CAN score) were less likely to be screened across all years, in accordance with national guidelines (aOR 0.72, 0.70-0.74). Conclusions LCS uptake in the VA (40.8%) exceeds national estimates (17.2%). Patients with advanced COPD or limited life expectancy were initially more likely to be screened, contrary to guidelines; this decreased over time but remained common. Integrating health metrics into clinician-facing dashboards may help clinicians prioritize LCS for patients most likely to benefit. This abstract is funded by: This work was supported in part by Career Development Award Number CX002713 from the United States (U.S.) Department of Veterans Affairs Clinical Science Research and Development Service (Dr. Rustagi). Dr. Rustagi also received support from the National Institute on Aging (1R03AG082924), VA’s Lung Precision Oncology Program, and VA’s VISN21 Early Career Award Program. The study sponsors had no role in the study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the manuscript for publication. The analysis was approved in accordance with all regulations by the Human Research Protection Program at the University of California, San Francisco and the San Francisco VA Health Care System (#24-41009). The opinions expressed herein are those of the authors and not their employers, the U.S. Department of Veterans Affairs, the U.S. government, or the study sponsors.