U.S. patients with a mental health illness have a considerably higher smoking prevalence and are nearly two times as likely to be eligible for CT lung cancer screening than individuals without a mental illness, according to a presentation at the recent RSNA 2018 meeting in Chicago.
There are numerous barriers to CT lung cancer screening that have limited its uptake to fewer than 2% of eligible smokers in recent years. Barriers from the patient's perspective include cost, lack of awareness, and the stigma of smoking; from the provider's side, there remain concerns about insurance coverage and additional work required to follow up on incidental findings, presenter Dr. Efren Flores from Massachusetts General Hospital told session attendees.
Several of these challenges may be even more pronounced for individuals with a mental illness, who are more likely than their peers to be smokers and have limited knowledge of screening opportunities, he noted.
In light of this trend, Flores and colleagues sought to determine whether individuals with a mental illness were more likely to be eligible for CT lung cancer screening. They conducted a retrospective evaluation of the 2015 U.S. National Health Interview Survey, which included the responses of approximately 11,000 individuals to health-related questions. More than 300 people reported having a mental illness among categories ranging from depression and anxiety to bipolar and attention deficit disorder.
For their analysis, the researchers focused on individuals between the ages of 55 and 77 years who were either current smokers or had quit within the past 15 years and had a smoking history of at least 30 pack-years.
Among participants who met these criteria, nearly twice the proportion of those with a self-reported mental illness were smokers and met the eligibility criteria for CT lung screening, compared with those who did not report a mental illness. The differences for both smoking prevalence and screening eligibility were statistically significant (p < 0.01).
| CT lung cancer screening eligibility for individuals with or without mental illness | ||
| Without mental health illness | With mental health illness | |
| Smoking prevalence | 12.9% | 25.8% |
| Eligible for CT lung screening | 10.6% | 18.7% |
A logistic regression analysis of the data also indicated that people with a mental illness were much more likely to be smokers (odds ratio of 2.2) and eligible for lung cancer screening (odds ratio of 1.89). At the population level, the results represent a projected 373,488 individuals with a mental health illness who would be eligible for lung screening.
"Currently, individuals with mental health illness are less likely to receive appropriate preventive health services," Flores said. "This gap will continue to widen if lung cancer screening implementation follows this pattern."
On the other hand, this challenge also paves the way to bridging a gap in healthcare and achieving equitable lung cancer screening participation, he noted.
"Targeted lung cancer screening outreach efforts are necessary for underserved populations," he said. "They highlight an opportunity for multidisciplinary outreach between radiology, primary care, and mental health for the benefit of all of our patients."
