Comments on a Misguided Focus on Screening Rates.

Hernandez's analysis of Behavioral Risk Factor Surveillance System (BRFSS) data concludes that adults of 78 to 79 years of age, who are excluded from Medicare coverage of lung cancer screening, have the highest uptake (32%) for lung cancer screening. They join other studies based on BRFSS that report much higher uptake than previous studies based on other sources. Potential social desirability, recall, and age-related biases and respondent clinical confusion in BRFSS and other sources lead us to question Hernandez's conclusions and the usefulness of uptake measures. Measuring the portion of newly diagnosed lung cancers detected through screening in administrative data is more closely connected to health outcomes. See related article by Hernandez et al., p. 693.