Lung Cancer Screening Adherence in Centralized versus Decentralized Screening Programs A Meta-Analysis of U.S. Cohort Studies Among Individuals with Negative Baseline Results.

Background: With growing interest in a centralized approach to lung cancer screening (LCS), pooling current evidence to estimate its impact on annual adherence is essential for aligning practice with guideline recommendations.

Objective: Is participation in a centralized screening program associated with higher adherence rates compared to decentralized programs among individuals with negative baseline LCS results?

Methods: We searched seven bibliographic databases for cohort studies published after January 1, 2011, reporting adherence outcomes for centralized versus decentralized LCS (primary outcome). Quality appraisal followed the Newcastle-Ottawa Scale for appraising observational studies. Random-effects meta-analysis was used to pool studies. Meta-regression examined patient- and institution-level characteristics associated with adherence in centralized programs.

Results: Twelve studies involving 17,195 patients with negative baseline results were included in this meta-analysis. The overall pooled adherence rate in centralized programs was 55% (95% CI: 42%-58%; 12 studies/11,302 patients) with 10-18 months of follow-up. Adherence was significantly higher in centralized compared to decentralized screening programs (68.9% vs. 37.1%; P < .0001), with a pooled OR of 3.33 (95%CI: 1.92-5.78; 4 studies/17,195 patients; moderate certainty). Substantial heterogeneity was observed across the four studies in the pairwise meta-analysis (I2 = 98.3%, P < .0001). Egger's regression test showed no significant funnel plot asymmetry (z = -0.374, P = .71), suggesting no evidence of publication bias. No association was found between adherence in centralized LCS and Lung-RADS category, follow-up duration, age, sex, race/ethnicity, smoking status, or institutional setting (P > .05; very low certainty).

Conclusions: Adherence to LCS remains low but is significantly higher in centralized screening programs compared to decentralized ones. Centralization may improve equity by addressing disparities associated with patient- and institution-level characteristics. Our findings support the expansion of centralized approaches and targeted quality improvement efforts to strengthen adherence to guideline-recommended LCS.