Perceptions and Beliefs Toward Lung Cancer Screening Among Older Smokers

BACKGROUND: In the United States, lung cancer is the leading cause of cancer-related death and 85% of cases are caused by smoking. Of all cancers, lung cancer has one of the lowest five-year survival rates (17%), but when diagnosed early, the five-year survival rate jumps to 52%. However only 15% of all lung cancer cases are diagnosed at an early stage. Recently there is strong evidence that lung cancer mortality is decreased by 20% with low-dose computed tomography (LDCT) screening for healthy individuals with an elevated risk for lung cancer (i.e., adults age 55-80 years, with a 30 pack-year smoking history who currently smoke or have quit within the past 15 years). Successful implementation of lung cancer screening guidelines depend on being able to reach high-risk individuals, yet studies show that those at higher risk (i.e., older smokers) are less interested in being screened despite awareness of risk. PURPOSE/AIMS: The purpose of this study was to survey a national sample of older smokers to identify what perceptions and beliefs are associated with the decision to have a LDCT scan. The aims for this study were to: 1) Identify the demographics, perceptions and beliefs associated with the decision to have an LDCT scan if “asked today”, and 2) Provide a predictive model of factors to explain a smokers’ willingness to have a LDCT scan. METHODS: During the month of July 2014, a national Qualtrics panel was conducted online; the sample includes 549 participants between the ages of 45 and 81. Eligible participants were older (≥ 45 yo), current and former smokers (<2 yrs. since cessation). Frequencies and descriptive statistics were run on all demographic variables and Pearson Correlations were conducted for participant demographics, number of years smoked and beliefs and perceptions associated with lung cancer screening. A logistic regression analysis was conducted to predict agreement to have a LDCT scan for lung cancer using perceptions and beliefs as predictors. RESULTS: None of the demographics were associated with lung cancer screening perceptions and beliefs. Eighty percent would agree to a LDCT today but only 26% have been told they are at high risk for lung cancer. Only 11% said a negative result would give them permission to continue to smoke. A test of the full model against a constant model was statistically significant, indicating that the predictors as a set reliably distinguished between those who would agree to a LDCT scan “today” and those who would not (Chi square 81.71, p < .0001, df = 5). The significant determinants were having beliefs that: screening will decrease risk of dying of lung cancer, they are at high risk for lung cancer, early detection of lung cancer will result in a good prognosis, and a negative result will decrease worry about lung cancer. Additional significant predictors were being worried about lung cancer and perceiving the screening as convenient and accurate. IMPLICATIONS: These results suggest the importance of education for older smokers about the accuracy of LDCT and the health advantages of lung cancer screening.