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Lung Cancer Screening Study Says Significant Disparities Persist Despite Expanded Eligibility

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While recent recommendations from the United States Preventive Services Task Force (USPSTF) to lower lung cancer screening thresholds significantly expanded eligibility for screening tests such as low-dose computed tomography (CT), differences in education, health-care insurance and proximity to health-care facilities continue to be key drivers of racial and socioeconomic disparities limiting access to appropriate preventive care.

Expanded eligibility doesn’t necessarily translate to expanded access to lung cancer screening. In a recent study looking at the impact of 2021 recommendations from the United States Preventive Services Task Force (USPSTF) to lower screening thresholds from 55 to 50 years of age and cumulative smoking exposure from 30 to 20 pack years, researchers found that racial and socioeconomic disparities still play significant roles in limiting access to preventive lung cancer screening.

Comparing lung cancer screening eligibility estimates after 2013 recommendations from the USPSTF to eligibility estimates after the 2021 recommendations from USPSTF, the study authors noted an overall 81.4 percent increase in eligibility for lung cancer screening. Breaking the increases down by race and ethnicity, the researchers noted a 242 percent increase in eligibility for non-Hispanic Asian people; a 113 percent increase for the Hispanic population; a 107.5 increase for non-Hispanic Black study participants; and a 77.9 percent increase for non-Hispanic White study participants, according to the study.1

However, the study authors also noted significant socioeconomic disparities that didn’t appear to change after the lowered screening thresholds from the 2021 USPSTF recommendations. In 2013, people with less than a high school diploma (20 percent) were four times less likely than those with a high school diploma or higher educational level (80 percent) to have lung cancer screening. After the 2021 recommendations, researchers estimated 19.1 of people of those with less than a high school diploma would be eligible for screening in comparison to 80.9 percent of those with a high school diploma or higher education.1

For people under the age of 65, the study authors also estimated that in 2013, people with no health care insurance were over 5.5 times less likely to have lung cancer screening in comparison to people with private insurance (10.9 percent versus 57.6 percent). Researchers noted similar percentages in the under 65 population after the 2021 recommendations with 57.1 percent of those with private insurance receiving lung cancer screening in comparison to 11 percent of those with no insurance.1

“Despite the increases in the proportion of individuals who are now eligible for (lung cancer screening) based on the updated (2021 USPSTF recommendations), further work is needed to mitigate inequities in access,” wrote study co-author Robert J. Volk, Ph.D., a Hubert L. and Olive Stringer Distinguished Professor in Cancer Research at the University of Texas MD Anderson Cancer Center, and colleagues.

In a subgroup analysis, Volk and colleagues examined racial disparities in lung cancer screening by comparing the impact of socioeconomic factors among participants after the 2021 USPSTF recommendations. Comparing non-Hispanic White study participants to non-Hispanic Black study participants, the researchers found a higher percentage of private health insurance (59.4 percent versus 44.5 percent) for those under 65 years of age; a lower percentage of those without a high school diploma (17 percent vs. 28.7 percent); and a lower percentage of people with income below the poverty level (14.9 percent vs. 26.2 percent).1

“Our findings show potential gaps, particularly among non-Hispanic Black individuals who have lower levels of education, income, and employment. These factors are important to consider within the context of exacerbating disparities that may compound upon one another,” noted Volk and colleagues.

The lack of transportation is another potential contributing factor to disparities in lung cancer screening, according to the study. The study authors said 11.1 percent of non-Hispanic Black study participants cited a lack of transportation as a reason for delaying medical care in comparison to 3.6 percent of non-Hispanic White study participants.1 Citing other research, Volk and colleagues said longer driving distances in combination with socioeconomic disparities can be a deterrent to timely screening with computed tomography (CT) lung cancer screening.2

“An analysis of census tract-level socioeconomic characteristics and distance to (American College of Radiology)-accredited computed tomography (CT) facilities showed increased driving distances to CT facilities for census tracts with higher proportions of individuals who are uninsured, have Medicaid, and have less than a high school degree,” pointed out Volk and colleagues.2

The study authors conceded a limitation of the study was using data from the 2015 National Health Interview Survey in order to assess a variety of socioeconomic factors that may impact lung cancer screening. Clinical considerations that could affect screening eligibility were not included in the study, according to Volk and colleagues.

References

1. 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. 2022 Jul 24. doi: 10.1002/cam4.5066. Online ahead of print.

2. Tailor D, Tong BC, Gao J, Choudhury KR, Rubin GD. A geospatial analysis of factors affecting access to CT facilities: implications for lung cancer screening. J Am Coll Radiol. 2019;16(12):1663-1668.

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