FARMINGTON, CT — Although the 2021 update to the United States Preventive Services Task Force guidelines for lung cancer screening (LCS) called for a reduction in disparities related to sex, race/ethnicity and socioeconomic status, few studies have looked at LCS adherence among female veterans.
A new study published in Women’s Health sought to do that, evaluating differences in adherence to LCS by sex. To do that, a team led by the University of Connecticut, Farmington, conducted a retrospective cohort study within the VA Connecticut LCS Program between June 2013 and March 2020.
The primary outcome was defined as nonadherence, i.e., the lack of completion of a chest CT scan within the guideline-recommended interval plus a 90-day grace period.
Researchers enrolled 4,711 eligible VHA patients in the screening program; all had baseline Lung-RADS scores of 1, 2, or 3. Patients with Lung-Reporting and Data System (RADS) 4 were excluded due to variability in follow-up recommendations.
Adjustments were made for age, race, smoking history, mental/medical comorbidities, and primary care (PC) visits (1-year after first/index CT).
Results indicated that the overall rate of nonadherence was 34%, with female veterans 66% more likely to be nonadherent to follow-up (odds ratio [OR] = 1.66, confidence interval [CI] = 1.19-2.30) compared with male veterans.
That occurred even though small cell cancer rates have declined much more slowly in women than men. In lung cancer in general, a shift in the demographic profile of patients has meant that increasing rates of adenocarcinoma in women, particularly those who have never smoked.
Substance use disorder was associated with greater nonadherence (OR = 1.22, CI = 1.01-1.47), according to the researchers who added that lower nonadherence also was observed among patients with chronic obstructive pulmonary disease (COPD) (OR = 0.77, CI = 0.66-0.9) and primary care engagement (OR for nonadherence with 5 or more PC visits = 0.78, CI = 0.67-0.91).
They added that the associations between sex and nonadherence were similar in models stratified by Lung-RADS groups 1-2 but did not reach significance for the Lung-RADS 3 group.
“In this cohort, female veterans were more likely nonadherent,” the authors concluded. “More work is needed to understand the distinct barriers to LCS follow-up among female veterans. Healthcare system engagement significantly reduced nonadherence, which may partially explain higher rates of nonadherence among female veterans who had fewer medical comorbidities.”
- Bernstein EL, Bade BC, DeRycke EC, Lerz K, Zeghlache R, Rose M, Kravetz J, Farmer MM, Bastian L, Akgün KM, Cain HC. The Association Between Sex and Lung Cancer Screening Adherence to Follow-Up in a Cohort of Veterans. J Womens Health (Larchmt). 2025 May;34(5):601-605. doi: 10.1089/jwh.2024.0780. Epub 2025 Mar 6. PMID: 40045919.
