Background Lung cancer screening (LCS) with low dose CT scan (LDCT) is effective at reducing lung cancer mortality in high risk current and former smokers. Despite being recommended by the U.S. Preventative Services Task Force (USPSTF), few eligible patients are screened. We set out to study the barriers to LCS by surveying primary care physicians (PCPs). Methods We surveyed a randomly selected sample of 1384 eligible primary care physicians (PCPs) between January and October 2015, using the American Medical Association Physician Masterfile, though surveys sent by mail, fax, and email. The survey included questions regarding knowledge of LCS guidelines, utilization of LCS over the prior 12 months, and perceptions of barriers to LCS. Training background, years in practice, practice type, and demographics were also collected. Results The survey response rate was 18%. Responders and non-responders did not differ by practice and demographic characteristics. 47% indicated that LCS was recommended by the USPSTF. 52% had referred any patient for LDCT and 12% had referred any patient to a LCS program over the prior 12 months. Perceived barriers to LCS included uncertainty regarding benefit of LCS, concern regarding insurance coverage, and harms of LCS. Conclusions Although LCS is recommended by USPSTF, LDCT is utilized in a minority of eligible patients, as reported by surveyed PCPs. About half of PCPs are familiar with USPSTF recommendations for LCS and a number of physician barriers to guideline adherence exist. Additional study on physician and system based interventions to improve adherence with LCS recommendations is needed.

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BACKGROUND: Studies examining the impact of lower socioeconomic status (SES) on the outcomes of patients with nonsmall cell lung cancer (NSCLC) are inconsistent. The objective of this study was to clearly elucidate the association between SES, education, and clinical outcomes among patients with NSCLC. METHODS: The study population was derived from a consecutive, retrospective cohort of patients with NSCLC who received treatment within the Duke Health System between 1995 and 2007. SES determinants were based on the individual's census tract and corresponding 2000 Census data. Determinants included the percentage of the population living below poverty, the median household income, and the percentages of residents with at least a high school diploma and at least a bachelor's degree. The SES and educational variables were divided into quartiles. Statistical comparisons were performed using the 25th and 75th percentiles. RESULTS: Individuals who resided in areas with a low median household income or in which a high percentage of residents were living below the poverty line had a shorter cancer-specific 6-year survival than individuals who resided in converse areas (P ¼ .0167 and P ¼ .0067, respectively). Those living in areas in which a higher percentage of residents achieved a high school diploma had improved disease outcomes compared with those living in areas in which a lower percentage attained a high school diploma (P ¼ .0033). A survival advantage also was observed for inhabitants of areas in which a higher percentage of residents attained a bachelor's degree (P ¼ .0455). CONCLUSIONS: Low SES was identified as an independent prognostic factor for poor survival in patients with both early and advanced stage NSCLC. Patients who lived in areas with high poverty levels, low median incomes, and low education levels had worse mortality. Cancer 2012;118:5117-23.

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