Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Published on May 20, 2021in CA: A Cancer Journal for Clinicians292.278
· DOI :10.3322/CAAC.21671
Ernesto Sosa1
Estimated H-index: 1
(City of Hope National Medical Center),
Gail D’Souza (City of Hope National Medical Center)+ 7 AuthorsLoretta Erhunmwunsee11
Estimated H-index: 11
(City of Hope National Medical Center)
Sources
Abstract
Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.
📖 Papers frequently viewed together
10 Citations
47 Citations
References88
Newest
#1Mina S. Sedrak (City of Hope National Medical Center)H-Index: 11
#2Rachel A. Freedman (Harvard University)H-Index: 25
Last. William Dale (City of Hope National Medical Center)H-Index: 40
view all 18 authors...
Cancer is a disease of aging and, as the world's population ages, the number of older persons with cancer is increasing and will make up a growing share of the oncology population in virtually every country. Despite this, older patients remain vastly underrepresented in research that sets the standards for cancer treatments. Consequently, most of what we know about cancer therapeutics is based on clinical trials conducted in younger, healthier patients, and effective strategies to improve clinic...
26 CitationsSource
The National Lung Cancer Screening Trial (NLST) demonstrated an improvement in overall survival with lung cancer screening. Achieving follow-up for a positive screen is essential to impact early intervention for lung cancer. The objective of this study was to determine predictors of follow-up after a positive lung cancer screening test. The NLST database was queried for participants with a positive lung cancer screening exam. This cohort was then subdivided into patients who had follow-up and th...
5 CitationsSource
#1Summer S. Han (Stanford University)H-Index: 22
#2Eric K.H. Chow (Stanford University)H-Index: 3
Last. Sylvia K. Plevritis (Stanford University)H-Index: 53
view all 11 authors...
BACKGROUND: Current U.S. Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55-80 y). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, due to other risk factors such as race, family history or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but missed by USPSTF guidelines in younger (50-54 y) and older...
13 CitationsSource
#1Mary Pasquinelli (UIC: University of Illinois at Chicago)H-Index: 5
#2Martin C. Tammemagi (Brock University)H-Index: 29
Last. Lawrence Eric Feldman (UIC: University of Illinois at Chicago)H-Index: 12
view all 10 authors...
Abstract Introduction Disparities exist in lung cancer outcomes between African American and white people. The current United States Preventive Services Task Force (USPSTF) lung cancer screening eligibility criteria, which is based solely on age and smoking history, may exacerbate racial disparities. We evaluated whether the PLCOm2012 risk prediction model more effectively selects African American ever-smokers for screening. Methods Lung cancer cases diagnosed between 2010 and 2019 at an urban m...
20 CitationsSource
#1Katrina Steiling (BU: Boston University)H-Index: 17
#2Taylor Loui (BU: Boston University)H-Index: 1
Last. Kei Suzuki (BU: Boston University)H-Index: 15
view all 8 authors...
ABSTRACT Background While lung cancer screening improves cancer-specific mortality and is recommended for high-risk patients, barriers to screening still exist. We sought to determine our institution’s screening rate, an urban safety net hospital, and to identify socioeconomic barriers to lung cancer screening. Methods We identified 8,935 smokers aged 55-80 evaluated by a primary care physician between March 2015 and March 2017 at our institution. We randomly selected one-third of these (n=2,978...
6 CitationsSource
#1Jennifer Richmond (UNC: University of North Carolina at Chapel Hill)H-Index: 6
#2Olive Mbah (UNC: University of North Carolina at Chapel Hill)H-Index: 6
Last. M. Manning (Cone Health)H-Index: 5
view all 8 authors...
Abstract Background Lung cancer is the leading cause of cancer death in the US, and significant racial disparities exist in lung cancer outcomes. For example, Black men experience higher lung cancer incidence and mortality rates than their White counterparts. New screening recommendations for low-dose computed tomography (LDCT) promote earlier detection of lung cancer in at-risk populations and can potentially help mitigate racial disparities in lung cancer mortality if administered equitably. Y...
5 CitationsSource
#1Nicole Ezer (McGill University)H-Index: 6
#2Grace MhangoH-Index: 16
Last. Juan P. WisniveskyH-Index: 60
view all 6 authors...
BACKGROUND: Racial disparities in resection of non-small cell lung cancer (NSCLC) are well documented. Patient-level and system-level factors only partially explain these findings. Although physician-related factors have been suggested as mediators, empirical evidence for their contribution is limited. OBJECTIVE: To determine if racial disparities in receipt of thoracic surgery persisted after patients had a surgical consultation and whether there was a physician contribution to disparities in c...
7 CitationsSource
#1Harry J. de Koning (EUR: Erasmus University Rotterdam)H-Index: 27
#2Carlijn M. van der Aalst (EUR: Erasmus University Rotterdam)H-Index: 21
Last. Matthijs Oudkerk (EUR: Erasmus University Rotterdam)H-Index: 94
view all 24 authors...
Abstract Background There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and...
513 CitationsSource
#1Peggy J. Ebner (SC: University of Southern California)H-Index: 4
#2Li Ding (SC: University of Southern California)H-Index: 7
Last. Elizabeth A. David (SC: University of Southern California)H-Index: 14
view all 9 authors...
Abstract Background Treatment decisions for patients with non-small cell lung cancer (NSCLC) are based upon patient and tumor characteristics, including socioeconomic status (SES) factors. The objective was to assess the contribution of SES factors to treatment and outcomes among patients with stage I NSCLC. Methods The National Cancer Database was queried for operable patients with stage I NSCLC. Patients were divided into 3 treatment groups: primary resection (SUR), nonstandard treatments (che...
10 CitationsSource
#1Patrick C. Yong (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 3
#2Keith Sigel (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 24
Last. Minal Kale (ISMMS: Icahn School of Medicine at Mount Sinai)H-Index: 13
view all 5 authors...
10 CitationsSource
Cited By1
Newest