Challenges and Opportunities for Lung Cancer Screening in Rural America

Abstract

Rural populations have higher rates of smoking and both lung cancer incidence and mortality compared with their urban peers. As such, it is imperative that high-risk, rural populations have access to recommended low-dose CT (LDCT) screening, which can detect lung cancer at an earlier, more treatable stage. Data from the 2015 National Health Interview Survey, a nationally representative survey, were analyzed to assess nonmetropolitan-metropolitan and geographic differences in LDCT utilization among screening-eligible individuals. Screening uptake did not differ by nonmetropolitan vs. metropolitan status (3.72% and 3.83%, respectively). Regional uptake varied from 1.58% in the West to 10.11% in the Northeast. Additionally, nonmetropolitan populations represent a disproportionately high 23% of the screening-eligible population despite accounting for only 15% of the US population. There are two key challenges to highquality LDCT screening experienced by rural populations: (1) geographic access to LDCT screening programs and (2) provider-patient communication. Despite the increased availability of LDCT screening centers since 2015, which is when most insurance plans began to cover the costs of screening, centers are geographically maldistributed relative to the rural-urban and regional need. Although decision aids can facilitate discussion between providers and patients regarding the risks and benefits of LDCT screening, research on the uptake and utility of these tools in rural areas is very limited. Analyses of population-based surveys and administrative and clinical data are needed to continue to surveil screening utilization, elucidate predictors of screening use, and inform shared decision-making tools and interventions for at-risk rural populations.

Urban–Rural Disparities in Access to Low-Dose Computed Tomography Lung Cancer Screening in Missouri and Illinois

“…Although rural areas are associated with poorer health outcomes than urban areas (25), we must also consider the urban-rural paradox, which suggests that among urban residents, greater distance to health care facilities is inversely associated with receiving care, but among rural residents, greater distance is positively associated with receiving care (26). Using 2015 data, Odahowski et al found that LDCT screening uptake was similar across metropolitan and nonmetropolitan counties, although low rates in both areas (<4%) make it difficult to understand why uptake is similar and whether the similarity will be maintained over time (27).…”

Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population

“…A disproportionate amount of the screening-eligible population resides in rural areas, 14 yet these areas often do not provide sufficient access to LCS facilities. 47,48 While some participants in this study indicated they would travel long distances to get screened for lung cancer, those participants tended to be highly motivated.…”

“…10,11 In 2016, the LCS rate in the United States was only 1.9%, 12 which likely saved about 233 lives-12 017 fewer than if everyone eligible were screened. 13 Despite rural areas having a disproportionately higher percent of people eligible for screening, LCS rates are no higher in rural areas than in other parts of the country, 14 and rural areas have unique challenges in getting patients screened. 4,14 Little is known about why LCS uptake remains so low, though there are likely compounding patient, facility, system, and health care provider factors, 4,15 including skepticism among the health care community 16 and difficulty identifying patients who meet the criteria to be screened.…”

Lung cancer screening implementation: Complexities and priorities

“…Currently, the US lung cancer screening centres are geographically maldistributed relative to the rural-urban and regional need. 76…”

“…This is likely to be replicated in lung cancer screening unless models of care that are more disposed towards rural dwellers can be designed and implemented. Currently, the US lung cancer screening centres are geographically maldistributed relative to the rural–urban and regional need 76 …”