The American Thoracic Society has released a statement in an attempt to address existing disparities in lung cancer screening eligibility and access in the United States.
A multidisciplinary panel was convened and reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities specific to lung cancer screening.
The panel found that existing lung cancer screening guidelines do not take into consideration racial. Ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. For example, shared decision-making tools are not designed for low health literacy and numeracy, or for culturally diverse populations.
Additionally, the panel identified several barriers, including access to screening and cost, that further contribute to inequities in implementation and dissemination of lung cancer screening. Among these were that rural high-risk individuals who smoke have reduced access to the geographic availability of screening centers, and that state-based variability in insurance coverage for screening marginalizes certain vulnerable populations.
The panel suggested several strategies to address these barriers including integration of patient navigators into lung cancer screening programs, provider-level support and education, and training for providers on communication techniques to build and improve patient trust.
They emphasized that “research scientists and health care providers should develop and test shared decision-making tools that are culturally sensitive and understandable by those with lower literacy and numeracy and those of differing cultural backgrounds.”
“Significant disparities across the continuum of lung cancer screening implementation — not getting screened for tobacco use, not meeting eligibility criteria, not having access to quality screening and tobacco treatment, and lack of insurance, among many — threaten to worsen disparities in lung cancer,” panel members wrote. “Dedicated efforts are needed to address existing multilevel barriers to lung cancer screening that widen disparities and to respond and develop actionable plans to implement strategies using multipronged approaches deployed simultaneously to decrease disparities.”
Rivera MP, Katki HA, Tanner NT, et al. Addressing disparities in lung cancer screening eligibility and healthcare access. An official American Thoracic Society statement. Am J Respir Crit Care Med. 2020;202(7):e95-e112.