Lung Cancer Screening: Challenges for Vulnerable Rural Populations

Lung cancer is the leading cause of cancer death in the United States, and it is estimated that smoking is the cause in approximately 80-90% of cases. Traditionally, tobacco prevention and cessation interventions have been the focus of efforts designed to decrease lung cancer incidence and mortality; unfortunately these programs are not always successful, and millions of current and former smokers remain at substantial risk for diagnosis. While researchers have more recently redirected their efforts to improving treatment options, interventions targeting the earliest stages of lung cancer diagnosis have proven most promising. Hence, shifting the focus from prevention and smoking cessation to early detection appears to be vital to decrease this disease’s threat.

The need to identify factors that predict successful enrollment of high-risk patients in early detection efforts is critical, especially given known disparities in uptake. In 2011, the National Lung Screening Trial (NLST) evaluated the utility of low-dose computed tomography (LDCT) for screening those at high-risk for lung cancer. They demonstrated a 20% reduction in lung cancer-specific mortality and a 6.7% reduction in all-cause mortality. This prompted 2012 guidelines recommending annual LDCT for “high-risk” patients defined as those: (1) 55-80 years of age, (2) with at least a 30 pack-year smoking history, (3) who are current smokers, or who have quit in the last 15 years. Despite a second study replicating the results of the NLST, today, lung cancer screening (LCS) is sadly under-utilized with less than 5% of eligible patients participating. We know the effects of these barriers are even more profound in less-populated areas. Hence, identification of the motivators of participation are vital to decrease these disparities, and interventions would benefit from prospective patient input.