Lung Cancer Screening in Colorado: Is the reach equitable?

Lung cancer is the leading cause of cancer death in Colorado, accounting for over 15% of the state's projected 8,480 cancer-related deaths in 2024. Most cases are diagnosed at late stages, limiting treatment options, increasing costs, and reducing quality of life. The National Lung Screening Trial (NLST) demonstrated that annual low-dose computed tomography (LDCT) screening reduces lung cancer mortality by 20%, prompting national screening guidelines. The U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare C Medicaid Services (CMS) recommend screening based on age, smoking history, and the ability to benefit from treatment.

Despite strong evidence, LDCT adoption remains low, with only 4.5% of eligible individuals screened nationwide and just 2.6% in Colorado. Additionally, disparities emerge across racial, economic, and geographic lines. To address this gap, we conducted an environmental scan of lung cancer screening in Colorado, leveraging diverse data sources to identify barriers, opportunities, and strategies for equitable screening implementation.

Data were obtained from the American College of Radiology on current lung cancer screening programs in Colorado and a comprehensive list of computed tomography devices. A road network analysis was conducted to assess geographic disparities in screening access.

At a range of 25 miles, individuals in rural and frontier regions face limited access to screening despite the disproportionate likelihood of eligibility for lung cancer screening. When adjusting the analysis to include all available computed tomography devices in Colorado, access is dramatically increased. Rural and frontier access appears to be more than double compared to current reach and cover the vast majority of the state.

Colorado has the resources to expand lung cancer screening given available technology (CT scanners), favorable insurance landscape, and reasonable access to lung cancer care. However, engagement among screening candidates, primary care clinicians, and communities remains low.

Leveraging existing resources could significantly improve screening uptake and lung cancer outcomes statewide.