“The State of Lung Cancer”: Single-Digit Low-Dose CT Screening and Significant Outcomes Disparities

November 20, 2020
Whitney J. Palmer

Third annual report from the American Lung Association reveals 94 percent of high-risk eligible patients are not getting screening with LDCT, and access and outcomes are worse for racial and ethnic minorities.

Low-dose CT (LDCT) for lung cancer screening has been heralded as a significant advancement for the safe detection of the disease, but to date, widespread implementation has been lacking.

According to a new report, released this week, by the American Lung Association (ALA), only 5.7 percent of the 8 million people who are at high-risk for developing the disease are actually undergoing screening.

This month has already seen a slew of publications revealing that, while LDCT does work to reduce lung cancer-related deaths, there is wide variation in who gets screened and where. With such a wide range for screening – Massachusetts has an 18.5 percent rate, but Nevada reports only 1 percent – it is difficult for radiologists and referring providers to know the best way to bolster screening utilization for this “silent killer.”

“The ‘State of Lung Cancer’ highlights that too many people are being left behind when it comes to making progress against lung cancer. We must all do more to address lung cancer for all communities,” said Harold Wimmer, ALA president and chief executive officer, in a statement accompanying this third annual lung cancer report. “To turn the tide against this deadly disease, Congress needs to protect and expand access to quality and affordable healthcare that helps more people who may be at high risk get screened and ensures that those diagnosed have access to treatment.”

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The “State of Lung Cancer” report, which pulls data from the American College of Radiology’s National Data Registry and North American Association of Central Caner Registries, tracks the annual toll that lung cancer takes on the states. For the first time this year, it focused on how the disease specifically impacts racial and ethnic minorities.

Overall, ALA experts said, lung cancer impacts racial and ethnic minorities more heavily than other groups. Not only are they less likely to be diagnosed early, but they are also less likely to undergo surgical treatment. In fact, it is more likely that they will receive no treatment due to their lack of access to quality and affordable healthcare. In particular, state Medicaid programs are among the handful of payers who are not required to cover lung cancer screening, and in many cases, the screenings require pre-authorization – a step that is frequently touted as being an impediment to utilization.

These Medicaid limitations can be a significant stumbling block for access to screening services, and they should be addressed, Wimmer said.

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“No one who wants treatment should have to forgo care due to lack of access or cost of treatment,” he said. “Lung cancer is often referred to as the silent killer, as it has few symptoms and is typically found in later stages when it’s less curable. The American Lung Association has long worked to bring lung cancer out of the shadows, and to fully uncover the toll of lung cancer and save more lives. To accomplish this, we must also address the disproportionate burden faced by people of color.”

Specifically, the report pointed to several significant disparities in the level of lung cancer treatment that racial and ethnic minorities receive compared to white patients. According to the report, the early diagnosis rates among African American patients are 16 percent lower than their white counterparts, and it is 13 percent lower for Latino patients. Additionally, surgical treatment rates are 19 percent lower for African American patients, as well as American Indians and Alaska Natives. Latino patients also had a 39 percent higher rate of not receiving treatment when white patients.

Despite these disparities and differences in care, there is a bright spot in the report. Lung cancer survival rates have been increasing. Since 2015, the number of people with five-year survivorship has increased by 13 percent to 22.6 percent nationally with Connecticut and Minnesota leading the way at 27.1 percent and 26.9 percent, respectively.

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