Background: The successful implementation of an equitable lung cancer screening program requires consideration of factors that influence accessibility to screening services. Methods: Using lung cancer cases in British Columbia (BC), Canada, as a proxy for a screen-eligible population, spatial access to 36 screening sites was examined using geospatial mapping and vehicle travel time from residential postal code at diagnosis to the nearest site. The impact of urbanization and Statistics Canada’s Canadian Index of Multiple Deprivation were examined. Results: Median travel time to the nearest screening site was 11.7 min (interquartile range 6.2–23.2 min). Urbanization was significantly associated with shorter drive time (p < 0.001). Ninety-nine percent of patients with ≥60 min drive times lived in rural areas. Drive times were associated with sex, ethnocultural composition, situational vulnerability, economic dependency, and residential instability. For example, the percentage of cases with drive times ≥60 min among the least deprived situational vulnerability group was 4.7% versus 44.4% in the most deprived group. Conclusions: Populations at risk in rural and remote regions may face more challenges accessing screening services due to increased travel times. Drive times increased with increasing sociodemographic and economic deprivations highlighting groups that may require support to ensure equitable access to lung cancer screening.

Background: Controversy remains about the optimal age at which screening mammography should be started. Methods: Cost-effectiveness analysis was based on a British Columbia birth cohort of 40,000 individuals, including 19,661 women alive at age 40. Ten screening scenarios were modeled: no screening versus best-in-the-world screening rates for ages 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 50-74, 40-74. The main outcomes included breast cancers treated by stage at diagnosis, deaths attributable to breast cancer averted, and quality-adjusted life years (QALY) gained or lost associated with ruling out false-positive results, receiving treatment, the metastatic phase, and living in remission. Results: Screening in women aged 50-74 would result in 92.9 deaths avoided and 889 QALYs gained, at a cost of $ 38,242 per QALY. Screening in women aged 40-74 would result in 99.6 deaths avoided and 744 QALYs gained, at a cost of $ 71,155 per QALY gained. Excluding patient time costs reduced the cost per QALY to $ 2,086 and $ 13,622, respectively. The only scenario in which benefits outweighed harms in women aged 40–49 was when harms attributable to false-positive results were excluded in the model, resulting in a cost per QALY of $ 138,594 and $ 83,210 in women aged 40-44 and 45-49, respectively. Conclusion(s): Our model results are highly sensitive to assumptions regarding utility losses associated with false-positive screening results and inclusion/exclusion of patient time costs, especially in younger women. Subsequent modeling investigations and policymakers who may utilize these investigations should be aware of the impact of these assumptions on model results.