The presence of comorbid conditions is associated with a higher likelihood of undergoing lung cancer screening with low-dose computed tomography (LDCT), according to study results published in the Annals of the American Thoracic Society.

Individuals with comorbidities are less likely to undergo cancer screening, and although lung cancer screening with LDCT is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in an older real-world US population is not well established. Therefore, researchers examined the relationships between comorbidity, functional status, and lung cancer screening utilization using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS).

The researchers used multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 vs ≥65 years), sex, and smoking history. Of the 11,214 participants who met the eligibility criteria for lung cancer screening based on US Preventive Service Taskforce (USPSTF) guidelines, 1731 (16%) underwent lung cancer screening with LDCT. The majority were White participants (90%), men (55%), former smokers (52%), and living with at least 1 chronic comorbid condition (77%).

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Approximately 28% had 3 or more comorbid conditions and 40% reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing lung cancer screening with LDCT within the past year was positively associated with higher levels of comorbidity, but not with functional limitations.

“Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of [lung cancer screening]-eligible individuals as well as the benefit versus harms ratio for older and sicker individuals who undergo LCS in real-world settings,” concluded the study authors.


Advani S, Zhang D, Tammemagi M, et al. Comorbidity profiles and lung cancer screening among older adults: U.S. behavioral risk factor surveillance system 2017 to 2019. Ann Am Thorac Soc. Published online April 29, 2021. doi:10.1513/AnnalsATS.202010-1276OC