Establishing Satellite Lung Cancer Screening Sites With Telehealth to Address Disparities Between High-risk Smokers and American College of Radiology-approved Centers of Designation.

L ung cancer is the leading cause of cancer deaths in the United States, and it is estimated that 142,670 Americans died from the disease in 2019.1 The 5-year survival rate of lung cancer of only 19.9% has led to increased efforts to screen and identify those patients most at risk. Evidence from the National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer–specific mortality over 3 years when low-dose computed tomography (LDCT) was compared with chest x-ray (CXR), with even more recent data in 2020 from the European NELSON trial revealing even more reduction in mortality, with a 24% reduction in men, and 33% in female individuals over 10 years.2 This has led numerous medical associations to endorse lung cancer screening.3 The United States Preventive Task Force (USPTF) issued a grade B recommendation for annual LDCT for lung cancer screening (LCS) for eligible individuals in 2013.4 The Centers for Medicare and Medicaid Services (CMS) subsequently added LCS counseling, shared decision-making visits (SDMV), and LDCT screening to the list of covered preventive services in 2015.5 In addition, the Affordable Care Act (ACA) has required private insurers to cover LCS without cost sharing. However, screening rates remain low. As of 2016, 1.9% of 7.6 million eligible individuals were screened according to the American College of Radiology (ACR) Lung Cancer Screening Registry.6 A widespread effort to identify barriers to LCS has addressed numerous contributing factors, including patient navigation and perceptions, reimbursement rates, and provider familiarity with current guidelines. Geographical disparities in smoking habits and access to screening resources have been identified, particularly between rural and urban populations. These disparities are particularly stark in the Southern United States, which has some of the highest smoking and poverty rates in the country. In the Commonwealth of Virginia, smoking rates and access to care are prominent case examples of the discrepancy many citizens face nationally. The adult smoking rate in Southwest Virginia (SWVA) is 30%, far exceeding the national average of 17% and 19% in Virginia as a whole. In Virginia, there are 51 ACR-accredited LDCT facilities, with only 2 being located in SWVA, where combustible tobacco use is highest (Fig. 1). A 2019 study by Tailor and colleagues found that 18.2% of smokers nationally live further that 15 miles from an ACR-accredited computed tomography (CT) facility, with some counties in Maine, Texas, Nevada, and Montana being > 100 miles away. In many of those same counties, there were over 10,000 smokers.7 Therefore, in establishing a telehealth initiative to address LCS disparities, one should consider both distance to CT facilities and regional smoking habits to determine which localities are most in need.