The study shows gaps in lung cancer screening despite updated guidelines

The study shows gaps in lung cancer screening despite updated guidelines

Since 2021, when lung cancer screening guidelines included younger people and people with less smoking history, the number of screenings increased, but among people with limited health care, according to a new study led by researchers at the Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.

“The updated guidelines significantly increased screenings for lung cancer overall, even as cancer screenings decreased during the Covid-19 pandemic,” said Tracy E. Crane, Ph.D., RDN, associate professor and co-leader of the Cancer Control Research Program at Sylvester. “However, discrepancies in who is screened persist, underscoring the importance of addressing structural barriers in rural and underserved populations.” Crane is senior author of the study, published in the March 20 issue ofJAMA -Oncology.

Lung cancer is the leading cause of cancer deaths in the United States for both men and women, and screenings can save lives by finding cancer early and making treatment more effective. Low-dose computed tomography (CT) is a relatively new screening tool for early-stage lung cancer.

The United States Task Force (USPSTF) published its first lung cancer screening guidelines in 2013. These screens are quick and painless. In 2021, the USPSTF updated the guidelines to start at 50 instead of 55 and to include those with a lower smoking history (20 or more pack-years instead of 30 or more). A pack-year is calculated by multiplying the number of years a person has smoked by the number of packs per day.

Lead author Lashae D. Rolle, MPH, C.Ph., a Sylvester Doctoral Research Fellow, used data on health-related risks and behaviors from a nationally representative CDC survey. The data set is large, but habits and risks are self-reported. Participants may underestimate how much they have smoked or be embarrassed to accurately report their habits.

Rolle found that of those considered high risk before the guidelines change, only 15.43% were up-to-date on their lung cancer screenings. In the year following the policy change, this increased to 47.08% of eligible shares up to date - better, but still less than half. The numbers were lower among uninsured patients, those without primary care providers and those living in rural areas.

Many barriers to care

Because patients without a primary care provider were much less likely to experience a barrier to referral. In other cases, the barrier may be knowledge – these patients may not even know they are eligible for screening.

Other barriers include the cost of care. Rolle noted that health insurance pays for 97% of lung cancer screenings. Without insurance, a scan can cost hundreds of dollars, in addition to paying for a doctor's visit to get a referral.

There are often options to access free or low-cost scans. Many states and nonprofits have programs to defer costs and increase access.

But screening is not a one-time deal. Patients should receive a scan annually and the results may require additional testing. The costs come not only from the scan but also from the follow-up. “

Coral Olazagasti, MD,study author,Sylvester Assistant Professor of Clinical Medical Oncology

"A person can say - I don't have the money; I don't have insurance. But no one thinks they have cancer," Rolle said. "I'm a cancer survivor myself. I was diagnosed at 26. I understand how easy it is to brush off screening, especially among those making the decision between food or screening."

In rural areas, screening facilities can be hundreds of miles apart, making it a barrier for many. Mobile lung cancer screening units can provide access to rural areas, but cost up to $2 million.

Ways to close the gap

In Sylvester, community outreach teams are working to close the disparities in lung cancer screenings.

"We identified the places in our catchment area where the highest risk patients are not being screened. We then ride the Game Changer Bus, educating and counseling the public about lung cancer screenings," said study author Estelamari Rodriguez, MD, MPH, Sylvester's Associate Director of Community Outreach for Thoracic.

Other ways to increase screening rates in minority populations include patient navigators, who can help educate patients, schedule their scans, and arrange transportation.

“Partnerships with local community organizations, churches and health workers have proven effective in promoting lung cancer screening,” said study author Gilberto Lopes, MD, Sylvester's chief of medical oncology. “Trusted local leaders can help overcome mistrust and fear while providing culturally tailored education.”

The gaps in access to lung cancer screening are personal to Rolle. "I was lucky enough to have an early recovery from breast cancer and now I am cancer-free. I would love to see others get screened so they can catch cancer early too," she said.

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