Who participates in LDCT screening for the early detection of lung cancer after long-term occupational exposure to asbestos dust? Results of the analysis of administrative and medical routine data from the German Social Accident Insurance.

BACKGROUND: Lung cancer is one of the most common cancers in Germany and is predominantly detected at an advanced stage. To ensure early detection, the German Social Accident Insurance (DGUV) offers lung cancer screening including a low-dose computed tomography (LDCT) for individuals with long-term occupational exposure to asbestos dust and a smoking history of at least 30 pack years. However, evidence remains scarce about what encourages this group of people to participate in LDCT screening after medical consultation.

METHODS: A secondary data analysis using routinely collected medical and administrative data between 2014 and 2024 was conducted in a cross-sectional design. This study aimed to investigate factors that could be used to predict the uptake of LDCT screening following a medical consultation. Exploratory logistic regression analysis was used to identify and assess possible predictors.

RESULTS: The sample included n = 14,491 individuals (97% male; average age 67 years; average asbestos dust exposure 21 years; average cigarette consumption 43 pack years). 74% of individuals underwent LDCT screening after medical consultation. 13 predictors were included in the regression model. The model demonstrated a low level of variance explanation (Nagelkerkes R2 = 0.026). Younger individuals (OR: 0.96, p < 0.001), individuals with prolonged exposure to asbestos dust (OR: 1.01, p = 0.011) and with a history of pneumonia (OR: 1.16, p = 0.011) were more likely to undergo LDCT screening.

CONCLUSION: The predictors showed only a low explanatory power. Further research should include non-participants and expand the exploratory model to include theoretically grounded predictors.