Distribution and Geographic Accessibility of Lung Cancer Screening Centers in the US.

Abstract

IMPORTANCE\nLung cancer is the leading cause of cancer death in the United States in part because only a minority of cases are diagnosed at a localized and potentially curable stage. The United States Preventive Services Task Force (USPSTF) has recommended annual screening with low dose CT for high-risk patients since 2013, though in 2015 less than 4% of those eligible were screened. These scans are to be performed at facilities which comply with high-quality screening practices developed by professional organizations, known as Screening Centers of Excellence (SCOE), which are concentrated in urban areas.\n\n\nOBJECTIVES\nTo estimate geographic accessibility of SCOEs in the continental U.S. in terms of travel time, to identify underserved areas, and to examine the association between travel time and lung cancer mortality.\n\n\nDESIGN\nWe conducted a drive-time analysis of SCOE for 2017. We used ArcGIS 10.8 software to geocode SCOE across the entire contiguous US. Drive-time estimates were computed using network analysis.\n\n\nSETTING\nAll SCOE in the 48 contiguous states in the U.\n\n\nS RESULTS\nWe found 416 (36%) of counties with high lung cancer mortality rates were beyond 1 hour drive time from a SCOE. These counties were clustered in the Deep South and the Appalachian regions of the US. The SAR model found a significant inverse association between distance to SCOE and lung cancer mortality. CONCLUSION AND RELEVANCE This study identifies high-need areas not currently served by an SCOE. Expanding screening centers to underserved areas could play an important role in increasing screening rates and ultimately reducing lung cancer mortality in the US.