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Lung Cancer Screening: Challenges for Vulnerable Rural Populations

Monday, October 18, 2021

Hasson RM. Lung Cancer Screening: Challenges for Vulnerable Rural Populations. October 2021. doi:10.25373/ctsnet.16803622

Lung cancer is the leading cause of cancer death in the United States, and it is estimated that smoking is the cause in approximately 80-90% of cases. Traditionally, tobacco prevention and cessation interventions have been the focus of efforts designed to decrease lung cancer incidence and mortality; unfortunately, these programs are not always successful, and millions of current and former smokers remain at substantial risk for diagnosis. While researchers have more recently redirected their efforts to improving treatment options, interventions targeting the earliest stages of lung cancer diagnosis have proven most promising. Hence, shifting the focus from prevention and smoking cessation to early detection appears to be vital to decrease this disease’s threat.

The need to identify factors that predict successful enrollment of high-risk patients in early detection efforts is critical, especially given known disparities in uptake. In 2011, the National Lung Screening Trial (NLST) evaluated the utility of low-dose computed tomography (LDCT) for screening those at high-risk for lung cancer. They demonstrated a 20% reduction in lung cancer-specific mortality and a 6.7% reduction in all-cause mortality. This prompted 2012 guidelines recommending annual LDCT for “high-risk” patients defined as those: (1) 55-80 years of age, (2) with at least a 30 pack-year smoking history, (3) who are current smokers, or who have quit in the last 15 years. Despite a second study replicating the results of the NLST, today, lung cancer screening (LCS) is sadly underutilized, with less than 5% of eligible patients participating. We know the effects of these barriers are even more profound in less-populated areas. Hence, identification of the motivators of participation are vital to decrease these disparities, and interventions would benefit from prospective patient input.





  1. Cancer Facts & Figures 2020. American Cancer Society®. (Accessed on October 1, 2020).
  2. Yamaguchi N, Mochizuki –Kobayashi Y, and Utsunomiya O. Quantifying relationship between cumulative cigarette consumption and lung cancer mortality in Japan. Int J Epidemiol 2000;29:963-968.
  3. Jernal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use and tobacco control. J Natl Cancer Inst 2008;100(23):1972-1994.
  4. Duma N, Santana-Davila R, Molina JR. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin Proc. 2019 Aug;94(8):1623-1640.
  5. Wedner R, Fontham ETH, Barrera E. Jr, Colditz GA, Church TR, Ettinger DS, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin. 2013;63:106-17.
  6. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307:2418-29.
  7. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Lung Cancer Screening. Version 1. 2013 (Accessed on October 3, 2020).
  8. American Lung Association. Providing Guidance on Lung Cancer Screening. The American Lung Association Interim Report on Lung Cancer Screening. (Accessed on September 15, 2020).
  9. Jacklitsch MT, Jacobson Fl, Austin JH, Field JK, Jett JR, Keshavjee S, et al. The American Association for Thoracic Surgery Guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012;144:33-38.
  10. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e78S-e92S.
  11. Lewis JA, Chen H, Weaver KE, Spalluto LB, Sandler KL, Horn L. Low Provider Knowledge is Associated with Less Evidence-Based Lung Cancer Screening. J Natl Compr Can Netw. 2019;17(4): 339-46.
  12. Li J, Chung S, Wei EK, Luft HS. New Recommendation and Coverage of Low-Dose Computed Tomography for Lung Cancer Screening: Uptake Has Increased But is Still Low. BMC Health Serv Res. 2018;18(1):525.
  13. Atkins GT, Kim T, Muson J. Residence in Rural Arears of the United States and Lung Cancer Mortality. Disease Incidence, Treatment Disparities, and Stage-Specific Survival. Ann Am Thorac Soc. 2017;3:403-


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