A80-2-34 From Recalcitrance to Receptivity: Blood-Based Lung Cancer Screening and Its Association With Uptake and Completion

Rationale

Lung cancer screening (LCS) with low-dose CT (LDCT) reduces disease mortality, but real-world implementation is limited by LDCT access and workflow impediments. We integrated DELFI FirstLook Lung (FLL), a blood-based genomic lung screening test, into our electronic health record (EHR) and clinical workflow to improve LCS rates in our health system, focusing on patients who were behind on screening.

Methods

From Oct 2024 through Nov 2025, we offered FLL to USPSTF-eligible patients. EHR-based decision support identified eligible patients and prompted providers and included patient navigation. Our payor partner provided reimbursement for FLL (with potential co-pay).

Results

Of the 2,567 patients eligible for LCS (1,412 of whom were LCS naïve), 1,248 (48%) were screened either with FLL (n = 368) or primary LDCT (n = 880) over the 14 month intervention, a three to four fold increase compared to the prior three time periods, which were 8.1% to 8.7% and 11.3%. When compared to patients who were offered primary LDCT screening, having the FLL blood test with a result of Elevated (“positive”) was associated both with greater LDCT completion rates (75.4% vs. 57.2%, p < 0.001) and more rapid follow through to LDCT completion both at beginning and end of period (51 down to 15 days and 95 down to 35 days, respectively). FLL testing reached a higher proportion of screening-naïve patients than did primary LDCT (62.5% vs 31.0%, p < 0.001). 25.5% of FLL tests were in those late on their annual repeat. Suspicious findings on LDCT were more common following FLL Elevated results than primary LDCT (RADS-3: 7.0% vs. 6.7%; RADS-4: 9.7%, vs 6.1%).

Conclusions

Implementation of FLL ordering as an option for LCS led to overall increases in screening through both blood and primary LDCT. The program improved uptake particularly among those who were screening naïve or tardy on annual LCS, suggesting that it was expanding the population being screened rather than displacing individuals who would be screened with LDCT otherwise. The blood test was also associated with higher and more rapid rates of follow through testing. Given the slow adoption of LDCT screening in the USPSTF eligible population, a point of care blood test has the potential to improve uptake and lower lung cancer mortality through higher rates of early detection.

This abstract is funded by: DELFI Diagnostics Grant Funding