High-Risk Individuals Delay Lung Cancer Screenings Until Eligible Despite Expanded Medicare Access
Key Takeaways:
- Medicare’s nearly-universal health care access for individuals age 65 or older is associated with increases in lung cancer screenings. An additional 5450 people received lung cancer screenings at age 65 rather than 64.
- Increases in lung cancer screenings at age 65 were similar for both men and women. Men had an additional 2888 screenings, and women had an additional 2600.
- Rural areas, where smoking is more common, showed higher increases in screenings at age 65 than urban areas, illustrating how lung cancer screenings are still well-targeted despite their increase.
Although lung cancer is the leading cause of cancer-related deaths in the US, lung cancer screening remains underutilized, with less than 20% of eligible individuals receiving screenings in 2022. The high cost of screening is an explanation for this utilization, especially for individuals who are uninsured. This study evaluated the impact of nearly-universal access to Medicare for individuals 65 years or older on lung cancer screening.
This study analyzed data from 2015 to 2020 recorded in the American College of Radiology’s Lung Cancer Screening Registry. The sample included 877 915 people aged 60 to 69 years who received initial lung cancer screenings. Of the screened individuals, 47% were women, 59% were men, 81% were from urban or suburban areas, and 19% lived in rural regions.
Health Care Coverage Increases Lung Cancer Screenings
The number of screenings increased at age 65, when individuals receive nearly universal Medicare coverage. An additional 5450 initial lung cancer screenings took place at 65 each year, or increased 41% relative to those who received screenings at 64.
Increases in lung cancer screenings at 65 were significant for both men and women. There was an increase of 2888 screenings among men and 2600 among women.
Screening rates at 65 were higher in rural areas than urban areas, 1231 vs 4241, respectively. This is likely because smoking is more prevalent in rural areas, so more individuals are eligible for screening than in urban areas.
While the number of initial lung cancer screenings increased, the study found no significant change in the number of diagnoses of lung cancer. For people screened at age 64, 0.56% received a lung cancer diagnosis. At age 65, 0.63% received a lung cancer diagnosis despite more people receiving screenings. This implies that screening remained well-targeted for people at high risk of lung cancer.
Implications for Providers
These findings indicate that high-risk individuals may delay receiving lung cancer screening until the age of 65. However, screening reduces cancer mortality, so these delays could lead to worse outcomes for patients with lung cancer.
The authors said, “Understanding the mechanisms by which Medicare increases lung cancer screening rates may help further increase screening in rural areas among people under 65.”
Reference
Perraillon MC, Warren A, Goldman L, Studts JL, Myerson RM. Delaying screening until covered? Changes in lung cancer screening at the age of nearly-universal Medicare insurance. Health Serv Res. 2026;61(2):e14638. doi:10.1111/1475-6773.14638
