Black patients referred to a lung cancer screening program experience lower rates of screening and longer time to follow-up

Michael Lake, Christine S Shusted, Hee-Soon Juon, Russell K McIntire, Charnita Zeigler-Johnson, Nathaniel R Evans, Gregory C Kane, Julie A Barta, Michael Lake, Christine S Shusted, Hee-Soon Juon, Russell K McIntire, Charnita Zeigler-Johnson, Nathaniel R Evans, Gregory C Kane, Julie A Barta

Abstract

Background: Racial disparities are well-documented in preventive cancer care, but they have not been fully explored in the context of lung cancer screening. We sought to explore racial differences in lung cancer screening outcomes within a lung cancer screening program (LCSP) at our urban academic medical center including differences in baseline low-dose computed tomography (LDCT) results, time to follow-up, adherence, as well as return to annual screening after additional imaging, loss to follow-up, and cancer diagnoses in patients with positive baseline scans.

Methods: A historical cohort study of patients referred to our LCSP was conducted to extract demographic and clinical characteristics, smoking history, and lung cancer screening outcomes.

Results: After referral to the LCSP, blacks had significantly lower odds of receiving LDCT compared to whites, even while controlling for individual lung cancer risk factors and neighborhood-level factors. Blacks also demonstrated a trend toward delayed follow-up, decreased adherence, and loss to follow-up across all Lung-RADS categories.

Conclusions: Overall, lung cancer screening annual adherence rates were low, regardless of race, highlighting the need for increased patient education and outreach. Furthermore, the disparities in race we identified encourage further research with the purpose of creating culturally competent and inclusive LCSPs.

Keywords: Cancer Screening; Lung Cancer; Lung Cancer Screening; Lung Cancer diagnosis; Racial disparities; Screening adherence.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT Diagram Displaying Sample Population

References

    1. Jemal A, Fedewa SA. Lung Cancer Screening with low-dose computed tomography in the United States-2010 to 2015. JAMA oncology. 2017;3(9):1278–1281.
    1. Centers for Disease Control and Prevention. What Are the Risk Factors for Lung Cancer? Atlanta, GA: Division of Cancer Prevention and Control, Centers for Disease Control and Prevention; 2018 [updated July 19th, 2018. Available from: .
    1. National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
    1. Force USPST. USPSTF Final Recommendation Statement: Lung Cancer Screening 2013 [Available from: .
    1. Services CfMaM. Decision Memo for Screening for Lung Cancer with Low-Dose Computed Tomography (LDCT) (CAG-00439N) 2015 [Available from: NCAId=274.
    1. Pham D, Bhandari S, Oechsli M, Pinkston CM, Kloecker GH. Lung cancer screening rates: Data from the lung cancer screening registry. Journal of Clinical Oncology. 2018;36(15_suppl):6504-.
    1. Carter-Harris L, Slaven JE, Jr, Monahan PO, Shedd-Steele R, Hanna N, Rawl SM. Understanding lung cancer screening behavior: racial, gender, and geographic differences among Indiana long-term smokers. Prev Med Rep. 2018;10:49–54.
    1. Tanner NT, Gebregziabher M, Hughes Halbert C, Payne E, Egede LE, Silvestri GA. Racial differences in outcomes within the National Lung Screening Trial. Implications for widespread implementation. Am J Respir Crit Care Med. 2015;192(2):200–208.
    1. Phelan JC, Link BG, Diez-Roux A, Kawachi I, Levin B. "fundamental causes" of social inequalities in mortality: a test of the theory. J Health Soc Behav. 2004;45(3):265–285.
    1. Aizer AA, Wilhite TJ, Chen MH, Graham PL, Choueiri TK, Hoffman KE, et al. Lack of reduction in racial disparities in cancer-specific mortality over a 20-year period. Cancer. 2014;120(10):1532–1539.
    1. Soneji S, Tanner NT, Silvestri GA, Lathan CS, Black W. Racial and ethnic disparities in early-stage Lung Cancer survival. Chest. 2017;152(3):587–597.
    1. Jonnalagadda S, Lin JJ, Nelson JE, Powell CA, Salazar-Schicchi J, Berman AR, et al. Racial and ethnic differences in beliefs about lung cancer care. Chest. 2012;142(5):1251–1258.
    1. Pang HH, Wang X, Stinchcombe TE, Wong ML, Cheng P, Ganti AK, et al. Enrollment trends and disparity among patients with Lung Cancer in National Clinical Trials, 1990 to 2012. J Clin Oncol. 2016;34(33):3992–3999.
    1. Cykert S, Dilworth-Anderson P, Monroe MH, Walker P, McGuire FR, Corbie-Smith G, et al. Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer. Jama. 2010;303(23):2368–2376.
    1. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211–233.
    1. Ryan BM. Lung cancer health disparities. Carcinogenesis. 2018;39(6):741–751.
    1. Zheng L, Enewold L, Zahm SH, Shriver CD, Zhou J, Marrogi A, et al. Lung Cancer Survival among Black and White Patients in an Equal Access Health System. Cancer Epidemiology Biomarkers & Prevention. 2012;21(10):1841.
    1. Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited Access to Care: Effect on Racial Disparity and Prognostic Factors in Lung Cancer. Cancer Epidemiology Biomarkers & Prevention. 2006;15(1):25.
    1. Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, et al. Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control. 2009;20(4):417–435.
    1. Williams CD, Salama JK, Moghanaki D, Karas TZ, Kelley MJ. Impact of race on treatment and survival among U.S. veterans with early-stage Lung Cancer. J Thorac Oncol. 2016;11(10):1672–1681.
    1. Japuntich SJ, Krieger NH, Salvas AL, Carey MP. Racial disparities in Lung Cancer Screening: an exploratory investigation. J Natl Med Assoc. 2018;110(5):424–427.
    1. Aldrich MC, Mercaldo SF, Sandler KL, Blot WJ, Grogan EL, Blume JD. Evaluation of USPSTF Lung Cancer Screening guidelines among African American adult smokers. JAMA oncology. 2019;5(9):1318–1324.
    1. DeSantis CE, Siegel RL, Sauer AG, Miller KD, Fedewa SA, Alcaraz KI, et al. Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities. CA Cancer J Clin. 2016;66(4):290–308.
    1. Duda C, Mahon I, Chen MH, Snyder B, Barr R, Chiles C, et al. Impact and costs of targeted recruitment of minorities to the National Lung Screening Trial. Clin Trials. 2011;8(2):214–223.
    1. Balekian AA, Wisnivesky JP, Gould MK. Surgical disparities among patients with stage I Lung Cancer in the National Lung Screening Trial. Chest. 2019;155(1):44–52.
    1. Mazzone P, Powell CA, Arenberg D, Bach P, Detterbeck F, Gould MK, et al. Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy Statement. Chest. 2015;147(2):295–303.
    1. Mazzone PJ, Silvestri GA, Patel S, Kanne JP, Kinsinger LS, Wiener RS, et al. Screening for Lung Cancer: CHEST guideline and expert panel report. Chest. 2018;153(4):954–985.
    1. Reid A, de Klerk NH, Ambrosini GL, Berry G, Musk AW. The risk of lung cancer with increasing time since ceasing exposure to asbestos and quitting smoking. Occup Environ Med. 2006;63(8):509–512.
    1. Alberg AJ, Nonemaker J. Who is at high risk for lung cancer? Population-level and individual-level perspectives. Semin Respir Crit Care Med. 2008;29(3):223–232.
    1. Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34(2):380–386.
    1. Gasperino J. Gender is a risk factor for lung cancer. Med Hypotheses. 2011;76(3):328–331.
    1. United States Census Bureau. American Communities Survey 5-Year Estimates 2010–2014. In: Bureau USC, editor. 2014.
    1. StataCorp. Stata Statistical Software: Release 14. College Station, Texas: StataCorp LP; 2015.
    1. Lung Cancer Alliance. Strengthening Adherence in Lung Cancer Screening. Washington, D.C.: Lung Cancer Alliance; 2017.
    1. National Colorectal Cancer Roundtable. Data and Progress: National Colorectal Cancer Roundtable; [Available from: .
    1. Narayan A, Fischer A, Zhang Z, Woods R, Morris E, Harvey S. Nationwide cross-sectional adherence to mammography screening guidelines: national behavioral risk factor surveillance system survey results. Breast Cancer Res Treat. 2017;164(3):719–725.
    1. Holmes JA, Chen RC. Racial Disparities in Time From Diagnosis to Treatment for Stage I Non–Small Cell Lung Cancer. JNCI Cancer Spectrum. 2018;2(1).
    1. Yang R, Cheung MC, Byrne MM, Huang Y, Nguyen D, Lally BE, et al. Do racial or socioeconomic disparities exist in lung cancer treatment? Cancer. 2010;116(10):2437–2447.
    1. Tanner NT, Porter A, Gould MK, Li XJ, Vachani A, Silvestri GA. Physician assessment of pretest probability of malignancy and adherence with guidelines for pulmonary nodule evaluation. Chest. 2017;152(2):263–270.
    1. American Thoracic Society and American Lung Association. American Thoracic Society and American Lung Association Lung Cancer Screening Implementation Guide. 2018.
    1. Arpey NC, Gaglioti AH, Rosenbaum ME. How socioeconomic status affects patient perceptions of health care: a qualitative study. J Prim Care Community Health. 2017;8(3):169–175.
    1. Bazargan M, Lucas-Wright A, Jones L, Vargas R, Vadgama JV, Evers-Manly S, et al. Understanding Perceived Benefit of Early Cancer Detection: Community-Partnered Research with African American Women in South Los Angeles. Journal of women's health (2002). 2015;24(9):755–61.
    1. Wang GX, Baggett TP, Pandharipande PV, Park ER, Percac-Lima S, Shepard J-AO, et al. Barriers to Lung Cancer Screening engagement from the patient and provider perspective. Radiology. 2019;290(2):278–287.
    1. Wildstein KA, Faustini Y, Yip R, Henschke CI, Ostroff JS. Longitudinal predictors of adherence to annual follow-up in a lung cancer screening programme. J Med Screen. 2011;18(3):154–159.
    1. Pasquinelli MM, Kovitz KL, Koshy M, Menchaca MG, Liu L, Winn R, et al. Outcomes from a minority-based Lung Cancer Screening program vs the National Lung Screening Trial. JAMA oncology. 2018;4(9):1291–1293.
    1. Guichet PL, Liu BY, Desai B, Surani Z, Cen SY, Lee C. Preliminary results of Lung Cancer Screening in a socioeconomically disadvantaged population. Am J Roentgenol. 2017;210(3):489–496.
    1. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
    1. Ryan BM. Differential eligibility of African American and European American lung cancer cases using LDCT screening guidelines. BMJ Open Respiratory Research. 2016;3(1):e000166.
    1. Li C-C, Matthews AK, Rywant MM, Hallgren E, Shah RC. Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking. Cancer Causes Control. 2019;30(3):235–240.

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