Racial Differences in Adherence to Lung Cancer Screening Follow-up

Kunitomo, Yukiko; Bade, Brett C.; Gunderson, Craig G.; Akgün, Kathleen M.; Brackett, Alexandria; Cain, Hilary; Tanoue, L.T.; Bastian, Lori A.

doi:10.1016/j.chest.2021.07.2172

Cited by 49 publications

(41 citation statements)

References 47 publications

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“… 20 LCS may offer a greater mortality benefit for non-Hispanic Black individuals than non-Hispanic White individuals, 15 and non-Hispanic Black individuals are at higher risk of dying from lung cancer. 49 Therefore, the racial inequalities in screening rates observed in this study and others 16 , 17 , 18 , 19 as well as those in terms of LCS eligibility 20 and adherence 50 , 51 , 52 merit urgent attention. Recent changes to US Preventive Services Task Force eligibility criteria to lower the age and pack-year history of screening eligibility (from 55 to 50 years, and from 30 to 20 pack-years, respectively) are in part intended to equalize screening access across racial and ethnic groups, as non-Hispanic Black individuals experience higher rates of lung cancer than non-Hispanic White individuals with the same cigarette usage and same age.…”

Section: Discussionmentioning

confidence: 80%

Likelihood of Lung Cancer Screening by Poor Health Status and Race and Ethnicity in US Adults, 2017 to 2020

2022

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Section: Discussionmentioning

confidence: 80%

Likelihood of Lung Cancer Screening by Poor Health Status and Race and Ethnicity in US Adults, 2017 to 2020

2022

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“…The programs reached different demographic segments of the population, potentially providing a means of overcoming the looming problem of access disparity to lung cancer screening, which threatens to widen racial, sex, and socioeconomic and geographic disparities in lung cancer mortality. 11 - 15 , 35 - 42 …”

Section: Discussionmentioning

confidence: 99%

Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort

Osarogiagbon¹,

Liao²,

Faris³

et al. 2022

JCO

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PURPOSE Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection—low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules. METHODS A prospective observational study enrolled patients in the early detection programs. For context, we compared them with patients managed in a Multidisciplinary Care Program. We compared clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. RESULTS From 2015 to May 2021, 22,886 patients were enrolled: 5,659 in LDCT, 15,461 in Lung Nodule, and 1,766 in Multidisciplinary Care. Of 150, 698, and 1,010 patients diagnosed with lung cancer in the respective programs, 61%, 60%, and 44% were diagnosed at clinical stage I or II, whereas 19%, 20%, and 29% were stage IV ( P = .0005); 47%, 42%, and 32% had curative-intent surgery ( P < .0001); aggregate 3-year overall survival rates were 80% (95% CI, 73 to 88) versus 64% (60 to 68) versus 49% (46 to 53); 5-year overall survival rates were 76% (67 to 87) versus 60% (56 to 65) versus 44% (40 to 48), respectively. Only 46% of 1,858 patients with lung cancer would have been deemed eligible for LDCT by US Preventive Services Task Force (USPSTF) 2013 criteria, and 54% by 2021 criteria. Even if all eligible patients by USPSTF 2021 criteria had been enrolled into LDCT, the Nodule Program would have detected 20% of the stage I-II lung cancer in the entire cohort. CONCLUSION LDCT and Lung Nodule Programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing Lung Nodule Programs may alleviate emerging disparities in access to early lung cancer detection.

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“…Despite substantial evidence for benefits in idealized trial settings and near universal guideline recommendations supporting screening in high risk populations,3 early evidence from the US suggests poor implementation of screening along the care continuum. This includes low uptake among eligible adults (approximately 5-15%)45 and poor adherence to follow-up rounds of screening at less than 50% compared with 90% in trial settings 67. Whether a substantial mortality benefit from screening can be achieved in real world settings without vastly improved implementation has remained uncertain.…”

mentioning

confidence: 99%