Original Article

CME Article: Factors Affecting Patient Adherence to Lung Cancer Screening

Authors: Christina Bellinger, MD, Kristie Foley, PhD, Frank Genese, MD, Aaron Lampkin, DO, Stephen Kuperberg, MD


Objectives: The National Lung Screening Trial (NLST) demonstrated a 20% reduction in mortality with low-dose computed tomography (CT) for lung cancer screening (LCS). The NLST found the greatest benefit to LCS for patients who underwent annual screening for a full 3-year follow-up period. The adherence to serial imaging in the NLST was 95%.

Methods: We conducted a prospective study of 268 patients who presented for LCS and who were not enrolled in a research study to determine the adherence to recommended follow-up imaging and biopsy at a single center. We evaluated the correlations among sociodemographic characteristics, Lung Imaging and Reporting Data System, and adherence.

Results: Only 48% of the patient population received recommended follow-up (either imaging or biopsy) after their referent LCS. Patients with abnormal LCS (Lung Imaging and Reporting Data System 3 or 4) were more likely to adhere to the recommended follow-up (additional imaging or biopsy) compared with those with negative screens. Sex, ethnicity, smoking status, and household income were not correlated with adherence to screening and biopsy.

Conclusions: The benefits from LCS observed in the NLST may be undermined by low adherence to follow-up screening. Studies targeting LCS patients to bolster adherence to follow-up are needed.

Posted in: Medical Oncology44

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Centers for Disease Control and Prevention. Lung cancer statistics. https://www.cdc.gov/cancer/lung/statistics. Accessed February 21, 2020.
2. The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
3. US Preventive Services Task Force. Final recommendation statement. Lung cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening. Published December 31, 2013. Accessed June 30, 2020.
4. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed November 10, 2019.
5. Triplette M, Thayer JH, Pipayath SN, et al. Poor uptake of lung cancer screening: opportunities for improvement. J Am Coll Radiol 2019;16(4 Pt A):446–450.
6. De Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020;382:503–513.
7. Montes U, Seijo LM, Campo A, et al. Factors determining early adherence to a lung cancer screening protocol. Eur Respir J 2007;30:532–537.
8. Wildstein KA, Faustini Y, Yip R, et al. Longitudinal predictors of adherence to annual follow-up in a lung cancer screening programme. J Med Screen 2011;18:154–159.
9. Hirsch EA, New ML, Brown SP, et al. Patient reminders and longitudinal adherence to lung cancer screening in an academic setting. Ann Am Thorac Soc 2019;16:1329–1332.
10. Alshora S, McKee BJ, Regis SM, et al. Adherence to radiology recommendations in a clinical CT lung screening program. J Am Coll Radiol 2018;15:282–286.
11. Pinsky PF, Gierada DS, Black W, et al. Performance of Lung-RADS in the National Lung Screening Trial. A retrospective assessment performance of Lung-RADS in the NLST. Ann Intern Med 2015;162:485–491.
12. Singh GK, Williams SD, Siahpush M, et al. Socieconomic, rural-urban, and racial inequalities in US cancer mortality: Part I—all cancers and lung cancer and lung cancer and Part II—colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol 2011;2011:107497.
13. Wood DE, Eapen GA, Ettinger DS, et al. Lung cancer screening. JNCCN 2012;10. DOI: 10.6004/jnccn.2012.0022.
14. Kaminetzky M, Milch H, Shmukler A, et al. Effectiveness of Lung-RADS in reducing false-positive results in a diverse, underserved, urban lung cancer screening cohort. J Am Coll Radiol 2019;16:419–426.
15. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Poverty guidelines. https://aspe.hhs.gov/poverty-guidelines. Published January 8, 2020. Accessed February 10, 2020.