Assessing Potential Racial, Ethnic Differences in Lung Cancer Screening in Hawaii

Researchers examined differences in lung cancer screening and follow-up rates among individuals residing in Hawaii.

Findings of a cohort study carried out in Hawaii revealed racial and ethnic disparities in lung cancer screening (LCS) completion rates following disaggregation of Native Hawaiian, Pacific Islander, and Asian individuals and their subgroups. Results were published in JAMA Network Open.

Lung cancer is the leading cause of cancer deaths in the United States, authors explained, adding previous research on cancer incidence and mortality among Asian American, Native Hawaiian, and Pacific Islander (AANHPI) individuals showed disproportional lung cancer incidence and mortality rates among these groups.

In addition, cancer data on AANHPI individuals are typically presented in aggregate, potentially masking differences among racial subgroups, authors noted.

To better understand LCS completion and follow-up rates among men, women, Asian (Chinese, Filipino, Japanese, and Korean) subgroups, Native Hawaiian individuals and Pacific Island individuals, investigators assessed data of those enrolled in the Kaiser Permanente Hawaii (KPHI) LCS program.

The population-based cohort study included electronic medical record (EMR) data of members who met criteria between 2015 and 2019.

All individuals were aged between 65 and 79 years, had a 30 pack-year smoking history, and were cancer free. Participants were also current smokers or had quit within the past 15 years, and were at least 5 years past any lung cancer diagnosis or treatment.

Smoking is estimated to account for between 80% and 90% of all lung cancer cases.

Of the 1030 individuals included in the analysis, 838 (81%) completed LCS, defined as completion of a low-dose computed tomography (LDCT) test based on EMR data. Mean (SD) patient age was 65.6 (5.8) years and 61% were male. “The largest racial and ethnic groups were non-Hispanic White (381 participants [37.0%]), Native Hawaiian or part Native Hawaiian (186 participants [18.1%]), and Japanese (146 participants [14.2%]),” authors wrote.

Analyses revealed:

  • Men and Filipino, Chinese, Japanese, and non-Hispanic White individuals had a higher proportion of screen orders for LDCT compared with women and individuals of the other racial and ethnic groups
  • Screening completion rates were not significantly different; but there was a 14% to 15% screening completion rate gap among groups
  • Asian individuals had the highest screening completion rate (266 participants [86%]) followed by Native Hawaiian (149 participants [80%]) and non-Hispanic White individuals (305 participants [80%]), Pacific Islander (50 participants [79%]) individuals, and individuals of other racial and ethnic groups (68 participants [77%])
  • Within Asian subgroups, Korean (31 participants [94%]) and Japanese (129 participants [88%]) individuals had the highest completion rates followed by Chinese individuals (28 participants [82%]) and Filipino individuals (78 participants [79%])
  • Of the 54 participants with Lung-Imaging Reporting and Data System (RADS) stage 3 disease, 93% (50 participants) completed a 6-month surveillance LDCT test
  • Of 37 individuals with Lung-RADS stage 4 disease, 35 (97%) were followed-up for additional procedures

Lower screening rates could be due to a multitude of factors including no insurance, longer distances to screening sites, or lower income levels. “Social and behavioral factors associated with LCS participation among racial and ethnic groups and by sex should be further examined among disaggregated racial and ethnic groups to identify target groups and areas for intervention,” authors wrote.

To help promote equity in screening eligibility for women, researchers suggested future studies examine LCS completion and follow-up rates in the same racial and ethnic groups and by sex using the US Preventive Services Task Force’s updated guidelines.

Small sample sizes mark a limitation to the current study, as researchers were unable to fully examine racial and ethnic differences and diagnostic outcomes.

“Disaggregation of these racial and ethnic groups is needed in future research involving larger samples to validate our findings and allow for a deeper dive into the social and behavioral factors that may be associated with LCS completion rates,” authors concluded.

“This would inform the work toward mitigating racial and ethnic disparities that may exist in LCS and provide specific guidance to the care delivery system in developing targeted, culturally sensitive intervention," they said.


Oshiro CES, Frankland TB, Mor J, et al. Lung cancer screening by race and ethnicity in an integrated health system in Hawaii. JAMA Netw Open. Published online January 20, 2022. doi:10.1001/jamanetworkopen.2021.44381