Abstract Introduction Lung cancer screening (LCS) with low-dose computed tomography (LDCT) significantly reduces lung cancer mortality but remains severely underutilized. Less than 10% of eligible adults undergo screening, with even lower screening rates in under-resourced populations. DELFI FirstLookTM Lung (FLL) is a high sensitivity cell-free DNA (cfDNA) blood-based lung cancer screening test that can be collected at home, making it a potentially convenient option for individuals facing barriers to LCS. Results are returned as “Elevated”, or “Not-Elevated”, where “Elevated” results require follow-up by LDCT. We evaluated the feasibility of FLL in an under-resourced population to identify characteristics of individuals interested in using blood-based testing as an initial step in LCS. Methods This prospective cohort study enrolled LCS-eligible adults (age 50-80, 20 pack-years, quit 15 years) from an urban Federally Qualified Health Center, an academic LCS program serving underserved populations, and community outreach events. Eligible participants were offered either at-home FLL testing via mobile phlebotomy or LDCT at a local imaging facility. Participants who selected FLL testing were encouraged to complete LDCT regardless of the blood test result. Baseline surveys assessed screening history and LCS health beliefs including barriers to LCS. Participants were recontacted 6-months after enrollment to evaluate acceptability and LDCT completion. Feasibility was defined as ≥ 30% preferring FLL. Results Fifty-five participants were enrolled: 39 (68%) chose FLL, while 16 (28%) chose LDCT. Demographics, education, prior cancer screening, and perceived stigma related barriers were similar between the two groups. Participants choosing FLL more often reported barriers to LCS, including lack of a regular provider, cost concerns, and transportation difficulties (p = 0.04 for each). Convenience (50%) and faster testing (21%) were the main reasons for selecting FLL. Better cancer detection (73%) and physician recommendation (9%) motivated choosing LDCT. Of those selecting FLL, two later opted for LDCT, three did not complete testing, two are pending collection, and one is pending results. 48% (15/31) of FLL participants had “Elevated-risk” results, of whom 92% (11/12) completed LDCT within 6 months. Of those with “Not-Elevated” results, 50% (5/10) completed LDCT within 6 months. Among those choosing LDCT alone, 69% (9/13) completed LDCT within 6 months. Conclusions In an underserved population, more than twice as many individuals selected at-home blood-based testing for LCS over LDCT, and nearly all individuals with an “Elevated-risk” result completed LDCT within six months. These results suggest that LCS rates could be improved in underserved populations if blood-based testing were an available option. This abstract is funded by: American Cancer Society
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