Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera, M. Patricia; Katki, Hormuzd A.; Tanner, Nichole T.; Triplette, Matthew; Sakoda, Lori C.; Wiener, Renda Soylemez; Cardarelli, Roberto; Carter‐Harris, Lisa; Crothers, Kristina; Fathi, Joelle T.; Ford, Marvella E.; Smith, Robert A.; Winn, Robert A.; Wisnivesky, Juan P.; Henderson, Louise M.; Aldrich, Melinda C.

doi:10.1164/rccm.202008-3053st

Cited by 145 publications

(153 citation statements)

References 135 publications

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“…Our results do not demonstrate differences in LCS volumes before vs during COVID-19 among nonwhite patients or rural patients, both of whom persistently have experienced disparities in lung cancer outcomes and other cancer screening modalities. 9 Additionally, our results do not suggest that patients at high risk of COVID-19 complications (ie, patients who are obese, have COPD, or have hypertension) were less likely to undergo LCS. Our study is limited to four lung imaging sites in one state, and our findings should be confirmed in other geographic areas where pandemic responses may have differed.…”

Section: Discussioncontrasting

confidence: 55%

Impact of the COVID-19 Pandemic on Volumes and Disparities in Lung Cancer Screening

Henderson

Benefield

Bosemani

et al. 2021

Chest

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The COVID-19 pandemic has impacted cancer screening, [1][2][3] with multistate data reporting reductions in breast, colon, and cervical cancer screenings but not reporting on lung cancer screening (LCS). 4 In late April 2020, the Radiological Society of North America COVID-19 Task Force suggested postponing nonurgent outpatient imaging, including LCS. 3 Also in April 2020, an expert panel of 24 physicians provided guidance for LCS during the pandemic, stating it was appropriate to defer enrollment in LCS for new patients and to delay annual screening but that patient preferences should also be considered. 1 Patients eligible for LCS have significant smoking exposure and underlying comorbidities, 5 putting this group at increased risk for infection and severe complications from COVID-19. Although two studies reported reductions in LCS at the start of the pandemic, 6,7 differences in screening volumes based on patient characteristics and COVID-19 risk factors were not reported. We sought to compare LCS volumes from multiple screening centers before and during the pandemic to determine whether patients who underwent LCS differ based on sociodemographic and COVID-19 risk factors. If certain subgroups of the population are less likely to undergo LCS or delay LCS during the ongoing COVID-19 pandemic, this may impact downstream lung cancer disparities.

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Section: Discussioncontrasting

confidence: 55%

Impact of the COVID-19 Pandemic on Volumes and Disparities in Lung Cancer Screening

Henderson

Benefield

Bosemani

et al. 2021

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“…38 Consequently, the American Thoracic Society recently advocated that screening eligibility should be assessed based on risk, in order to reduce such disparities. 95…”

Section: Lung Cancer Risk and Screening Eligibility Disparitiesmentioning

confidence: 99%

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Haaf

Aalst

Koning

et al. 2021

Intl Journal of Cancer

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Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population-based screening programs. Due to smoking behaviour being the primary risk-factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk-based. In fact, the selection of high-risk individuals has been shown to be essential in implementing lung cancer screening in a cost-effective manner. Furthermore, studies have shown that further riskstratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk-based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk-based approaches can negatively influence the trade-off between individual benefits and harms if not applied thoughtfully. Large-scale implementation of targeted, risk-based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high-risk individuals from the general population. Finally, while risk-based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk-stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact. K E Y W O R D S lung cancer screening, personalised screening, risk-based screening Abbreviations: 4-IN-THE-LUNG-RUN, (Towards INdividually tailored INvitations screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) implementation trial; AUC, area under the receiver operating characteristic curve; BMI, body mass index; bioMILD, the Plasma microRNA Profiling as First Line Screening Test for Lung Cancer Detection: a

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“… 14 Collectively, these findings affirm the importance of developing culturally sensitive shared decision-making aids and educational materials in other primary languages and at appropriate literacy levels to mitigate inequities in LCS. 26 …”

Section: Discussionmentioning

confidence: 99%

Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

et al. 2021

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IMPORTANCEFor lung cancer screening to confer mortality benefit, adherence to annual screening with low-dose computed tomography scans is essential. Although the National Lung Screening Trial had an adherence rate of 95%, current data are limited on screening adherence across diverse practice settings in the United States. OBJECTIVE To evaluate patterns and factors associated with adherence to annual screening for lung cancer after negative results of a baseline examination, particularly in centralized vs decentralized screening programs. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study was conducted at 5 academic and community-based sites in North Carolina and California among 2283 individuals screened for lung cancer between July 1, 2014, and March 31, 2018, who met US Preventive Services Task Force eligibility criteria, had negative results of a baseline screening examination (American College of Radiology Lung Imaging Reporting and Data System category 1 or 2), and were eligible to return for a screening examination in 12 months. EXPOSURES To identify factors associated with adherence, the association of adherence with selected baseline demographic and clinical characteristics, including type of screening program, was estimated using multivariable logistic regression. Screening program type was classified as centralized if individuals were referred through a lung cancer screening clinic or program and as decentralized if individuals had a direct clinician referral for the baseline low-dose computed tomography scan. MAIN OUTCOMES AND MEASURES Adherence to annual lung cancer screening, defined as a second low-dose computed tomography scan within 11 to 15 months after baseline screening. RESULTS Among the 2283 eligible individuals (1294 men [56.7%]; mean [SD] age, 64.9 [5.8] years; 1160 [50.8%] aged Ն65 years) who had negative screening results at baseline, overall adherence was 40.2% (n = 917), with higher adherence among those who underwent screening through centralized (46.0% [478 of 1039]) vs decentralized (35.3% [439 of 1244]) programs. The independent factor most strongly associated with adherence was type of screening program, with a 2.8-fold increased likelihood of adherence associated with centralized screening (adjusted odds ratio [

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Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Cited by 145 publications

References 135 publications

Impact of the COVID-19 Pandemic on Volumes and Disparities in Lung Cancer Screening

Impact of the COVID-19 Pandemic on Volumes and Disparities in Lung Cancer Screening

Personalising lung cancer screening: An overview of risk‐stratification opportunities and challenges

Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

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