A80-2-21 Association Between Language Preference and Annual Lung Cancer Screening Adherence in a Regionally Integrated Healthcare System

Abstract Introduction Lung cancer screening (LCS) with a yearly low-dose CT saves lives, but the mortality benefit depends on timely adherence to at least three annual screens. Timely adherence remains suboptimal, and linguistic barriers may introduce additional challenges to obtaining screening. We examined the association between language preference (non-English vs. English) and longitudinal adherence to annual LCS. Methods We conducted a retrospective cohort study of LCS-eligible adults who underwent initial screening between January 1, 2015, and March 10, 2025, within a four-hospital regional health system serving a diverse urban and rural population across New England, including many from underserved backgrounds. Patients were screened through a hybrid LCS program in which dedicated program personnel support primary care clinicians in key screening activities. The key primary outcome was operationalized as a binary variable: having received two follow-up screens within the recommended 10-15-month interval versus having received either late (15 months) or no follow-up at any time point. The primary exposure was preferred language (non-English vs. English). Multivariable logistic regression models adjusted for age, sex, comorbidities, and neighborhood deprivation. Patients with Lung-RADS 3 or 4 results (i.e., high-risk findings for which closer follow-up or biopsy is recommended), new lung cancer diagnoses, death, or insufficient follow-up time were censored. Results Among 10,881 patients (mean age 62 ± 6.2 years; 50.7% male), 93.3% preferred English and 6.7% non-English. Non-English speakers were more frequently Hispanic (76% vs. 5%) and had a similar age and sex distribution but a higher prevalence of comorbidities, including diabetes, liver disease, renal disease, and HIV/AIDS. After the first screen, 58.8% completed screening within 10-15 months, 24.6% had no follow-up, and 15.4% had delayed follow-up. After the second screen, 46.0% completed screening within 10-15 months, 40.1% had no follow-up, and 12.2% were delayed. Non-English language preference was associated with lower odds of completing two timely annual screens compared with the English preference group (23.6% vs. 30.0%; unadjusted OR = 0.72, 95% CI 0.60-0.86; adjusted OR = 0.78, 95% CI 0.65-0.94). Conclusions In this large cohort of patients cared for within a community screening program, approximately 1 in 4 patients received two follow-up screens within the recommended timeframe. Non-English speakers were less likely to receive timely longitudinal screening. Interventions that promote linguistically tailored communication and navigation support are critical to improving overall screening adherence and advancing LCS equity. Table. Timely Lung Cancer Screening (LCS) Follow-Up by Language Preference This abstract is funded by: LUNGevity Foundation