Disparities in Lung Cancer Screening: A Review

Haddad, Devin; Sandler, Kim L.; Henderson, Louise M.; Rivera, M. Patricia; Aldrich, Melinda C.

doi:10.1513/annalsats.201907-556cme

Cited by 120 publications

(99 citation statements)

References 62 publications

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“…There is concern that inequitable eligibility guidelines and multilevel barriers to implementation of and access to LCS may exacerbate disparities in lung cancer outcomes. Herein, we expand our prior work ( 12 ) and propose strategies to reduce disparities in LCS dissemination and implementation with sufficient evidence and directed at vulnerable populations.…”

Section: Introductionmentioning

confidence: 93%

“…We define a healthcare disparity in LCS as occurring when two people at equal lung cancer risk and who have an equal harm-to-benefit ratio from LCS are not managed equitably. Vulnerable populations from groups that are socially, economically, demographically, or geographically defined may need additional care or support to achieve health equity in LCS ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

Self Cite

153

143

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Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination. Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS. Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS. Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

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Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

Self Cite

153

143

View full text Add to dashboard Cite

show abstract

“…Furthermore, as new screening, diagnostic, treatment approaches emerge, it is important to understand how access to and utilization of these services vary based on rurality and race/ethnicity. For example, low-dose CT screening for lung cancer was initially recommended by the USPSTF in 2013, but critics were concerned that the high pack-year history requirements meant that fewer Black smokers may be eligible for screening [ 205 , 206 ]. Subsequently, the USPSTF released a draft statement that, if implemented, would lower the screening age and pack-year eligibility requirement [ 207 ].…”

Section: Implications/recommendationsmentioning

confidence: 99%

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Zahnd

Murphy

Knoll

et al. 2021

IJERPH

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One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.

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“…This could exacerbate disparities in lung screening. 34 Our findings suggest that there are factors related to SES that increase lung cancer risk but are not captured by the variables in risk models or are related to differential measurement error for the variables in risk models. Further, the effects of USA educational and ethnicity categories on lung cancer risk are unlikely to align with these effects in the UK.…”

Section: Discussionmentioning

confidence: 62%

Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom

et al. 2021

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Background The National Health Service England (NHS) classifies individuals as eligible for lung cancer screening using two risk prediction models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2). However, no study has compared the performance of lung cancer risk models in the UK. Methods We analysed current and former smokers aged 40–80 years in the UK Biobank (N = 217,199), EPIC-UK (N = 30,813), and Generations Study (N = 25,777). We quantified model calibration (ratio of expected to observed cases, E/O) and discrimination (AUC). Results Risk discrimination in UK Biobank was best for the Lung Cancer Death Risk Assessment Tool (LCDRAT, AUC = 0.82, 95% CI = 0.81–0.84), followed by the LCRAT (AUC = 0.81, 95% CI = 0.79–0.82) and the Bach model (AUC = 0.80, 95% CI = 0.79–0.81). Results were similar in EPIC-UK and the Generations Study. All models overestimated risk in all cohorts, with E/O in UK Biobank ranging from 1.20 for LLPv3 (95% CI = 1.14–1.27) to 2.16 for LLPv2 (95% CI = 2.05–2.28). Overestimation increased with area-level socioeconomic status. In the combined cohorts, USPSTF 2013 criteria classified 50.7% of future cases as screening eligible. The LCDRAT and LCRAT identified 60.9%, followed by PLCOm2012 (58.3%), Bach (58.0%), LLPv3 (56.6%), and LLPv2 (53.7%). Conclusion In UK cohorts, the ability of risk prediction models to classify future lung cancer cases as eligible for screening was best for LCDRAT/LCRAT, very good for PLCOm2012, and lowest for LLPv2. Our results highlight the importance of validating prediction tools in specific countries.

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Disparities in Lung Cancer Screening: A Review

Cited by 120 publications

References 62 publications

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

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

The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States

Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom

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