Social Determinants of the Lung Cancer Care Continuum

Lung cancer is the leading cause of cancer death.1 Unfortunately, lung cancer affects certain populations disproportionately in terms of risk, screening, detection, and treatment. For example, smoking increases the risk of getting lung cancer by 10x, and those in lower income brackets and of lower education level are 2 to 3 times more likely to be smokers.2,3 Though annual lung cancer screening can decrease mortality4, minority and underserved populations are less likely to participate in screening and less likely to follow-up after a baseline scan.5-7 Low participation and compliance with lung cancer screening creates a missed opportunity to reduce mortality among these populations, thus exacerbating lung cancer disparity.7 Even when diagnosed, African Americans and those in the lowest socioeconomic quartile have significantly lower survival from lung cancer compared to others.8,9 This work details how disparities along the continuum of lung cancer care result in higher and morbidity.

1 https://www.cdc.gov/cancer/lung/statistics/index.htm 2 https://www.cdc.gov/tobacco/disparities/low-ses/index.htm 3 https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2021-poverty-guidelines#threshholds

4National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409.

5Jemal A, Fedewa SA. Lung Cancer Screening With Low-Dose Computed Tomography in the United States-2010 to 2015. Jama Oncol. 2017;3(9):1278-1281.

6 Sesti J, Sikora TJ, Turner DS, Turner AL, Langan RC, Nguyen AB, Paul S. Disparities in Follow-Up After Low-Dose Lung Cancer Screening. Semin Thorac Cardiovasc Surg. October 2019. doi:10.1053/j.semtcvs.2019.10.006.

7 Erkmen CP, Dako F, Moore R, Dass C, Weiner MG, Kaiser LR, Ma GX. Adherence to annual lung cancer screening with low-dose CT scan in a diverse population. Cancer Causes Control. 2021 Mar;32(3):291-298.

8Soneji S, Tanner NT, Silvestri GA, Lathan CS, Black W. Racial and Ethnic Disparities in Early-Stage Lung Cancer Survival. Chest. 2017 Sep;152(3):587-597.

9Tannenbaum SL, Koru-Sengul T, Zhao W, Miao F, Byrne MM. Survival disparities in non-small cell lung cancer by race, ethnicity, and socioeconomic status. Cancer J. 2014 Jul-Aug;20(4):237-45