Address Disparities in Lung Cancer Screening

Address disparities in lung cancer screening – a focus of several abstracts presented at ASCO’s 2021 annual meeting.

Lung cancer remains the leading cause of cancer death worldwide.¹ It carries a 5-year overall survival rate of less than 20%, mainly resulting from the often advanced stage at diagnosis.² Lung cancer screening guidelines were implemented by the National Comprehensive Cancer Network (NCCN) and the U.S. Preventive Services Task Force (USPSTF) in 2011 and 2013, respectively, after landmark clinical trials, such as the National Lung Screening Trial and The Dutch–Belgian Randomized Lung Cancer Screening Trial, showed earlier diagnosis and decreased mortality rates with low-dose CT (LDCT) as a screening modality.^3-6 Despite these recommendations, lung cancer screening remains vastly underused to date, with less than 20% of the high-risk eligible population undergoing lung cancer screening. Low rates of lung cancer screening are even more noticeable among underserved populations. Herein, we discuss three abstracts from the 2021 ASCO Annual Meeting that address disparities in lung cancer screening, including an abstract we coauthored (Table).

Address Disparities in Lung Cancer Screening Completions

Abstract 10506 aimed to determine (1) the uptake of baseline lung cancer screening among patients who received a referral for LDCT and (2) if there were individual or socioeconomic factors associated with LDCT compliance after a referral was placed. This retrospective population-based study was conducted within the five health systems of the Lung Population-Based Research to Optimize the Screening Process Consortium from January 2014 through June 2019. A total of 13,920 patients were referred for baseline lung cancer screening, of whom 70.3% were non-Hispanic White, 14.1% were non-Hispanic Black, and 15.7% were of other or unknown race/ethnicity. Of the patients who were referred for screening, 62% received LDCT. Patients who were male (63.6%), former smokers (65.9%), and older (64.2% age 65-69 and 64.1% older than age 70) had higher rates of LDCT screening after receiving a referral. Differences in screening completion were observed by race/ethnicity, with 81.8% of Asian/Pacific Islander, 63.3% of Hispanic, 56.1% of non-Hispanic Black, 61.8% of non-Hispanic White, and 55.2% of other-race patients undergoing LDCT after referral (p < 0.001). Additionally, the study found that non-Hispanic Black men were significantly less likely to undergo a baseline LDCT than non-Hispanic White men (odds ratio [OR] 0.87, 95% CI [0.84, 0.94]; p = 0.59), whereas non-Hispanic Black women had a higher tendency toward screening completion than non-Hispanic White women (OR 1.13, 95% CI [0.93, 1.38]).

This study highlights the need to further investigate the factors that may impact lung cancer screening uptake in different subgroups of individuals, which, in turn, could help physicians tailor population-specific interventions to promote adherence and decrease disparities.