Disparities in Lung Cancer Screening: A Review.
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ABSTRACT:
SUBMITTER: Haddad DN
PROVIDER: S-EPMC7175982 | biostudies-literature | 2020 Apr
REPOSITORIES: biostudies-literature
Publications
Disparities in Lung Cancer Screening: A Review.
Haddad Diane N DN Sandler Kim L KL Henderson Louise M LM Rivera M Patricia MP Aldrich Melinda C MC
Annals of the American Thoracic Society 20200401 4
Lung cancer is the leading cause of cancer mortality in the United States. Certain groups are at increased risk of developing lung cancer and experience greater morbidity and mortality than the general population. Lung cancer screening provides an opportunity to detect lung cancer at an early stage when surgical intervention can be curative; however, current screening guidelines may overlook vulnerable populations with disproportionate lung cancer burden. This review aims to characterize dispari ...[more]
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Project description:Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths in the US and worldwide. In particular, vulnerable populations such as those of low socioeconomic status (SES) are at the highest risk for and suffer the highest mortality from NSCLC. Although lung cancer screening (LCS) has been demonstrated to be a powerful tool to lower NSCLC mortality, it is underutilized by eligible smokers, and disparities in screening are likely to contribute to inequities in NSCLC outcomes. It is imperative that we collect and analyze LCS data focused on individuals of low socioeconomic position to identify and address barriers to LCS utilization and help close the gaps in NSCLC mortality along socioeconomic lines. Toward this end, this review aims to examine published studies that have evaluated the impact of income and education on LCS utilization, eligibility, and outcomes. We searched the PubMed, Ovid MEDLINE, and CINAHL Plus databases for all studies published from January 1, 2010, to October 21, 2020, that discussed socioeconomic-based LCS outcomes. The review reveals that income and education have impact on LCS utilization, eligibility, false positive rates and smoking cessation attempts; however, there is a lack of studies evaluating the impact of SES on LCS follow-up, stage at diagnosis, and treatment. We recommend the intentional inclusion of lower SES participants in LCS studies in order to clarify appropriate eligibility criteria, risk-based metrics and outcomes in this high-risk group. We also anticipate that low SES smokers and their providers will require increased support and education regarding smoking cessation and shared decision-making efforts.
| S-EPMC8264678 | biostudies-literature
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| S-EPMC7159416 | biostudies-literature
Project description:Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.
| S-EPMC8266751 | biostudies-literature
Project description:BackgroundAnnual lung cancer screening (LCS) with low-dose chest computed tomography for high-risk individuals reduces lung cancer mortality, with greater reduction observed in Black participants in clinical trials. While racial disparities in lung cancer mortality exist, less is known about disparities in LCS participation. We conducted a systematic review to explore LCS participation in Black compared with White patients in the USA.MethodsA systematic review was conducted through a search of published studies in MEDLINE, PubMed, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied-Health Literature Database, from database inception through October 2020. We included studies that examined rates of LCS participation and compared rates by race. Studies were pooled using random-effects meta-analysis.ResultsWe screened 18,300 titles/abstracts; 229 studies were selected for full-text review, of which nine studies met inclusion criteria. Studies were categorized into 2 groups: studies that reported the screening rate among an LCS-eligible patient population, and studies that reported the screening rate among a patient population referred for LCS. Median LCS participation rates were 14.4% (range 1.7 to 62.6%) for eligible patient studies and 68.5% (range 62.6 to 88.8%) for referred patient studies. The meta-analyses showed screening rates were lower in the Black compared to White population among the LCS-eligible patient studies ([OR]=0.43, [95% CI: 0.25, 0.74]). However, screening rates were the same between Black and White patients in the referred patient studies (OR=0.94, [95% CI: 0.74, 1.19]).DiscussionBlack LCS-eligible patients are being screened at a lower rate than White patients but have similar rates of participation once referred. Differences in referrals by providers may contribute to the racial disparity in LCS participation. More studies are needed to identify barriers to LCS referral and develop interventions to increase provider awareness of the importance of LCS in Black patients. Trial Registry PROSPERO; No.: CRD42020214213; URL: http://www.crd.york.ac.uk/PROSPERO.
| S-EPMC9585128 | biostudies-literature
Project description:BackgroundLung cancer (LC) is the leading cause of cancer-related deaths in the United States (U.S.), with non-White people who smoke often bearing the burden of the highest rate of LC mortality. This is often due to later stage diagnoses, leading to poor prognosis and outcomes. We assess here how the eligibility criteria for LC screening set by the U.S. Preventive Services Task Force (USPSTF) and the Centers for Medicare and Medicaid Services (CMS) could contribute to racial disparities in screening access.MethodsThis paper analyzes data from the National Health and Nutrition Examination Survey (NHANES), an annual survey conducted by the Centers for Disease Control and Prevention (CDC) that gathers health and nutrition data from a representative sample of the U.S. population. After excluding those who were ineligible for LC screening, the final cohort of participants was 5,001, which consisted of 2,669 people who formerly smoked and 2,332 people who currently smoke.ResultsOut of 608 participants who were eligible for LC screening, 77.5% were non-Hispanic White (NHW) and 8.7% were non-Hispanic Black (NHB) participants versus 69.4% and 10.8% among 4,393 ineligible participants. Age, pack-years, and age along with pack-years were the most frequent reasons for ineligibility. LC screening ineligible NHW participants were statistically significantly older and had higher mean pack-years than the other racial and ethnic groups. NHB participants among the ineligible group had higher urinary cotinine levels compared to NHW participants.ConclusionsThis paper underscores the need for more individualized risk estimates when determining eligibility for LC screening, which could include biomarkers of smoking exposure. The analysis shows that current screening criteria, which rely solely on factors such as age and pack years, contribute to LC racial disparities.
| S-EPMC10261853 | biostudies-literature
Project description:ImportanceRacial disparities in lung cancer screening (LCS) are often ascribed to barriers such as cost, insurance status, access to care, and transportation. Because these barriers are minimized within the Veterans Affairs system, there is a question of whether similar racial disparities exist within a Veterans Affairs health care system in North Carolina.ObjectivesTo examine whether racial disparities in completing LCS after referral exist at the Durham Veterans Affairs Health Care System (DVAHCS) and, if so, what factors are associated with screening completion.Design, setting, and participantsThis cross-sectional study assessed veterans referred to LCS between July 1, 2013, and August 31, 2021, at the DVAHCS. All included veterans self-identified as White or Black and met the US Preventive Services Task Force eligibility criteria as of January 1, 2021. Participants who died within 15 months of consultation or who were screened before consultation were excluded.ExposuresSelf-reported race.Main outcomes and measuresScreening completion was defined as completing computed tomography for LCS. The associations among screening completion, race, and demographic and socioeconomic risk factors were assessed using logistic regression models.ResultsA total of 4562 veterans (mean [SD] age, 65.4 [5.7] years; 4296 [94.2%] male; 1766 [38.7%] Black and 2796 [61.3%] White) were referred for LCS. Of all veterans referred, 1692 (37.1%) ultimately completed screening; 2707 (59.3%) never connected with the LCS program after referral and an informational mailer or telephone call, indicating a critical point in the LCS process. Screening rates were substantially lower among Black compared with White veterans (538 [30.5%] vs 1154 [41.3%]), with Black veterans having 0.66 times lower odds (95% CI, 0.54-0.80) of screening completion after adjusting for demographic and socioeconomic factors.Conclusions and relevanceThis cross-sectional study found that after referral for initial LCS via a centralized program, Black veterans had 34% lower odds of LCS screening completion compared with White veterans, a disparity that persisted even after accounting for numerous demographic and socioeconomic factors. A critical point in the screening process was when veterans must connect with the screening program after referral. These findings may be used to design, implement, and evaluate interventions to improve LCS rates among Black veterans.
| S-EPMC10276308 | biostudies-literature
Project description:BackgroundCurrent US Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55-80 years). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, because of other risk factors such as race, family history, or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but were missed by USPSTF guidelines in younger (50-54 years) and older (71-80 years) age groups.MethodsWe used data from the National Health Interview Survey, the CISNET Smoking History Generator, and results of logistic prediction models to simulate lifetime lung cancer risk-factor data for 100 000 individuals in the 1950-1960 birth cohorts. We calculated age-specific 6-year lung cancer risk for each individual from ages 50 to 90 years using the PLCOm2012 model and evaluated age-specific screening eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3% and 2.5%).ResultsIn the 1950 birth cohort, 5.4% would have been ineligible for screening by USPSTF criteria in their younger ages but eligible based on risk-based criteria. Similarly, 10.4% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, high proportions of blacks were ineligible for screening by USPSTF criteria at younger (15.6%) and older (14.2%) ages, which were statistically significantly greater than those of whites (4.8% and 10.8%, respectively; P < .001). Similar results were observed with other risk thresholds and for the 1960 cohort.ConclusionsFurther consideration is needed to incorporate comprehensive risk factors, including race and ethnicity, into lung cancer screening to reduce potential racial disparities.
| S-EPMC7669226 | biostudies-literature
Project description:ObjectiveLow dose computed tomography (LDCT) became the standard method for lung cancer (LC) screening in 2013. However, it is unclear whether there are differences in survival rates based on sex and whether the differences depend on screening status. We aimed to evaluate the LC survival rates between females and males based on screening.Material and methodsThis retrospective cohort study examined data from the Boston LC Study (BLCS) between 2013 and 2021. LC screening depends on patients' demographics (age and smoking history) to determine whether a person is a high-risk individual and, therefore, undergo LDCT. Descriptive statistics were calculated for race, age, histology, smoking history, stage, and treatment. These variables' distributions were compared between sex and screening status using t-test and chi-square, respectively. Cox proportional hazards model and Kaplan-Meier curves were used to compare survival between sex and screening. Propensity score matching was applied to account for selection bias in screening when evaluating the association between screening and stage.ResultsA total of 1,216 LC patients were identified with a screening incidence of 9.4 %, among whom 56 % were female. Unscreened males had 1.59 times higher risk of mortality than unscreened females (P=.0002) and had a worse 5-year survival (male 50 %; 95 %CI, 0.38,0.6 vs female 70 %; 95 %CI,0.62,0.76). In contrast, there were no significant differences in survival between sexes among screened. In a balanced cohort of screened and unscreened, the odds of being diagnosed at late stages for females and smokers were 1.33 and 2.51 times that of males and nonsmokers; however, there were no statistical significance.ConclusionUnscreened females had a lower risk of mortality and better survival than unscreened males, while among the screened population, there was no difference in the overall survival. These observations demonstrate the influence of sex on survival prognosis in LC when screening is not performed.
| S-EPMC9618021 | biostudies-literature
Project description:BackgroundLow-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization.MethodsGuided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity).DiscussionThe study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates.Trial registrationClinicalTrials.gov, NCT04675476. Registered December 19, 2020.
| S-EPMC10870584 | biostudies-literature
Project description:ImportanceLung cancer in individuals who have never smoked (INS) is a growing global concern, with a rapidly increasing incidence and proportion among all lung cancer cases. Particularly in East Asia, opportunistic lung cancer screening (LCS) programs targeting INS have gained popularity. However, the sex-specific outcomes and drawbacks of screening INS remain unexplored, with data predominantly focused on women.ObjectiveTo compare LCS outcomes between Asian women and men with no smoking history.Design, setting, and participantsThis multicenter cohort study was conducted at health checkup centers in South Korea from 2009 to 2021. Participants included individuals aged 50 to 80 years with no smoking history who underwent low-dose computed tomography (LDCT) screening. Data were retrospectively analyzed from November 2023 to June 2024.ExposuresOpportunistic LDCT screening for lung cancer.Main outcomes and measuresParticipants were followed up until December 2022 for the outcome of death. Lung cancer diagnosis, diagnostic characteristics, clinical course, and lung cancer-specific deaths (LCSD) were compared between women and men.ResultsA total of 21 062 participants (16 133 [76.6%] women and 4929 [23.4%] men) with a mean (SD) age of 59.8 (7.2) years were included. From baseline screening, 176 participants (139 women [0.9%] and 37 men [0.8%]) were diagnosed with lung cancer (screen-detected); 131 of 139 women (94.3%) and 33 of 37 men (89.2%) were diagnosed with stage 0 to I disease, with 133 of 139 women (95.7%) and 36 of 37 men (97.3%) having adenocarcinoma. There were no significant sex-based differences in stage or histologic type distribution. Among the 21 062 screened individuals, LCSD was reported in 8 women and 3 men during a mean (SD) follow-up of 83.8 (41.7) months. Multivariable analyses found no significant association between sex and cumulative hazards of lung cancer diagnosis (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.64-1.26] for men vs women) or LCSD (aHR, 1.06 [95% CI, 0.28-4.00] for men vs women). The estimated 5-year lung cancer-specific survival rate was 97.7% for women and 100% for men with screen-detected lung cancer, showing no significant sex differences.Conclusions and relevanceIn this cohort study of Asian individuals with no smoking history who underwent LDCT screening, no significant sex-based differences were detected in lung cancer diagnosis, stage distribution, or LCSD. These findings suggest that men and women who have never smoked would experience similar risks of overdiagnosis with little to no benefit when exposed to indiscriminate screening.
| S-EPMC11736501 | biostudies-literature