Healthcare Disparity in Lung Cancer Screening
Healthcare disparity affects cancer screening1. While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients2, 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 Black race, pulmonary comorbidities like COPD, personal history of malignancy and family history of lung cancer are more prevalent in the safety net patients. For example, while National Lung Screening Trial population had less than 5% Black population, Boston Medical Center (BMC) sees 35-40% Black population3. And more of BMC patients have pulmonary comorbidities and family history of lung cancer compared to NLST.
Secondly, not only could the safety net population be at higher risk for lung cancer, they are also probably less likely to be screened. We estimate lung cancer screening rate at BMC to be about 16%3. Even amongst our safety net population, Black race 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 part, lack of trust with the health system or personnel, language barriers, or lack of access to care4. It is essential to raise awareness as a group and identify ways to mitigate the disparity in lung cancer screening.
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).