More people are eligible for screening, but a new analysis suggests lung cancer disparities are due to more than eligibility status.
A new analysis suggests that efforts to reduce lung cancer disparities by expanding screening eligibility are unlikely to erase gaps in outcomes.
Last year, the United States Preventive Services Task Force (USPSTF) unveiled new recommendations designed to help mitigate lung cancer disparities by changing screening eligibility in a way that increased the number of individuals classified as non-White who qualified. Black Americans are more likely to receive a diagnosis of late-stage lung cancer vs Whites, even though data show the former tend to smoke cigarettes at a lower intensity. The new guidelines lowered the age of qualification for screening from 55 to 50 years and the minimum cumulative smoking exposure needed to qualify for screening from 30 to 20 pack years. Yet, it is not known whether these new recommendations will result in a narrowing of disparities.
Investigators from MD Anderson Cancer Center and the University of Mississippi Medical Center wanted to see how the changes might have an impact on racial disparities in lung cancer and better understand the barriers to care that contribute to those disparities. They used data from the National Health Interview Survey to analyze the new recommendations, looking at factors such as education, poverty, insurance status, and reasons for delaying medical care.
Results were published in Cancer Medicine.
The analysis confirmed that the number of people who would qualify for screening would increase under the new recommendations. They nearly doubled, from 7.9 million under the 2013 guidelines to 14.2 million under the 2021 guidelines.
Yet, when the authors looked at subgroups based on drivers of disparities, they found a higher proportion of Black survey respondents did not have high school diplomas compared with White respondents (28.7% vs 17.0%; P= .002) who were living in poverty (26.2% vs 14.9%; P < .001). In addition, they found Black respondents were more likely to experience a lack of work and delay medical care due to a lack of transportation.
The authors said the new recommendations would likely reduce disparities with optimal uptake and adherence to the screening guidelines. However, they said real-world community adherence is much different than that of a clinical trial setting.
“Despite the increases in the proportion of individuals who are now eligible for [lung cancer screening] based on the updated recommendation, further work is needed to mitigate inequities in access,” the authors wrote.
They said the socioeconomic factors they identified, including a lower level of education, have also been linked with factors that can increase health risk. For instance, people without a high school diploma are more likely to use tobacco, and people who are uninsured are less likely to utilize the health care system.
The authors noted that providers can help address the disparities by using individualized risk assessments when considering screening eligibility and by helping to increase awareness of the guidelines.
“At the patient level, integrating patient navigators, interventions to address health literacy, and efforts to reduce medical mistrust may help in reducing barriers to screening and improving lung cancer outcomes among minority populations,” they concluded.
Maki KG, Talluri R, Toumazis I, Shete S, Volk RJ. Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility. Cancer Med. Published online July 24, 2022. doi:10.1002/cam4.5066