Health Care Disparities in Lung Cancer Screening

Health care disparities affect cancer screening (1). While lung cancer screening improves rates of cancer-specific mortality and is recommended for high-risk patients (2), barriers to screening still exist. First, the safety net patients may be at higher risk of harboring lung cancer. Some of the known risk factors of lung cancer such as ethnic background, pulmonary comorbidities like COPD, personal history of malignancy, and family history of lung cancer are more prevalent in safety net patients. For example, while less than 5% of participants in the National Lung Screening Trial population were black, 35-40% of the patients being screened at Boston Medical Center (BMC) are black (3). And more of BMC patients have pulmonary comorbidities and a family history of lung cancer compared to NLST participants.

Secondly, not only could the safety net population be at higher risk for lung cancer, patients in this group are also probably less likely to be screened. We estimate the lung cancer screening rate at BMC to be about 16% (3). Even amongst our safety net population, particular ethic backgrounds and lower income (income based on zip code) were associated with a person not being screened. The causes are likely multi-factorial such as lack of knowledge about the benefits of screening, lack of recommendation on the physician's part, lack of trust with the health system or personnel, language barriers, or lack of access to care (4). It is essential to raise awareness amongst vulnerable populations regarding the benefits of lung cancer screening and identify ways to mitigate related disparities.

References

1. Sabatino, S.A., et al. Cancer screening test use - United States, 2013. MMWR Morb Mortal Wkly Rep 64, 464-468 (2015).
2. National Lung Screening Trial Research, T., et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365, 395-409 (2011).
3. Steiling, K., et al. Age, Race, and Income Are Associated With Lower Screening Rates at a Safety Net Hospital. Ann Thorac Surg 109, 1544-1550 (2020).
4. Kale, M.S., Wisnivesky, J., Taioli, E. & Liu, B. The Landscape of US Lung Cancer Screening Services. Chest 155, 900-907 (2019).

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