Baseline prevalence of lung cancer screening and covariates among women undergoing breast cancer screening in Missouri.

e22562 Background: We sought to evaluate lung cancer screening (LCS) uptake and determine factors associated with LCS among women participating in a highly-attended breast cancer screening (BCS) program in Missouri. Methods: We conducted a retrospective cohort study using electronic health record data (2019 to 2025) of women aged 50–80 years with documented smoking history undergoing BCS at Barnes-Jewish West County (BJWCH), serving ~4,500 women, and Christian Hospital (CH), serving ~9,000 women in Missouri. LCS eligibility was assessed based on current smoking status, > 20 smoking pack-years, and/or < 15 years since quitting among former smokers. We evaluated LCS uptake and conducted multivariable analyses to explore demographic, behavioral, and area-level characteristics associated with LCS eligibility and uptake. Results: A total of 8,709 women had ever smoked; 2,530 from BJWCH and 6,179 from CH. Most women were non-Hispanic Black (52.4%) and non-Hispanic White (45.2%), with CH serving mostly Blacks (67.6%) and BJWCH primarily White (80.6%). At BJWCH, 30% of women, and at CH, 34.6% had undergone LCS. Only 37% of patients had documented pack-years. Documentation of pack-years was more likely among current smokers (AOR = 1.89; 95% CI: 1.69–2.11; p < 0.001) and was associated with higher likelihood of LCS (AOR = 3.27; 95% CI: 2.97–3.60; p < 0.0001). LCS uptake among those with documented pack-years was 43.8% (N = 411) and 54.6% (N = 1,251) at BJWCH and CH, respectively. Current smoking status was associated with higher LCS uptake (AOR = 2.05, 95% CI: 1.82–2.31, p < 0.001) compared to former smoking status. A dose–response relationship was observed with pack-years and LCS (table 1). Residence in higher neighborhood deprivation was associated with a higher likelihood of LCS (table 1). Effect modification by race/ ethnicity attenuated the positive association between smoking > 40 pack-years and LCS among non-Hispanic Blacks (AOR = 2.03 (95% CI: 1.02–4.03), p = 0.036). Conclusions: LCS uptake among women remains low, and poor documentation of pack-years undermines accurate LCS eligibility determination. LCS uptake was lower among those with former smoking status, and the attenuated association between high pack-years and LCS among non-Hispanic Blacks suggests potential disparities in translating risk to LCS. System-level efforts to strengthen pack-year documentation and LCS-eligibility assessment, particularly among former smokers, could expand uptake of LCS. Variable Reference group AOR 95% CI p-value Pack-year documentation Documented vs not 3.27 2.97–3.60 <0.0001 Smoking status Current vs former 2.05 1.82–2.31 <0.001 Pack-years 20–29 pack years 30–39 1.7 1.27–2.28 <0.001 ≥40 2.79 2.11–3.68 <0.001 Undocumented 0.19 0.16–0.23 <0.001 Area deprivation Category 1 Category 2 1.12 0.87 – 1.45 0.371 Category 3 1.33 1.04–1.69 0.023 Category 4 1.59 1.26–2.00 <0.001