Delaying Screening Until Covered? Changes in Lung Cancer Screening at the Age of Nearly-Universal Medicare Insurance

Abstract

Objective: To estimate changes in lung cancer screening at age 65, the age of nearly universal Medicare coverage. Study Setting and Design: Screening reduces lung cancer mortality but is underutilized. We used a regression discontinuity design to measure the impact of nearly universal Medicare coverage at age 65 on first-time receipt of screening (primary outcome) and the proportion of screened individuals with detected lung cancer (secondary outcome). Data Sources and Analytic Sample: First-time screens at age 60–69 in the American College of Radiology's Lung Cancer Screening Registry data, 2015–2020. Principal Findings: Nearly-universal access to Medicare at 65 increased first-time lung cancer screening by 5450 per year (CI 4911–5990), a 41% increase compared to age 64. Eighty-nine percent of additional screens were among people who met screening eligibility criteria. Increases at age 65 were larger in rural areas than nonrural areas (52% vs. 39%) and were similar for men and women (41% and 42%). There was no statistically significant change in the proportion of screened individuals with lung cancer detected. Conclusion: First-time receipt of lung cancer screening increases at age 65, particularly among people in rural areas. Cancer detection rates did not worsen, suggesting screening remained well targeted as it increased.