Lung cancer screening less common among those most likely to benefit from it
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Individuals whose underlying poor health may make them less likely to benefit from lung cancer screening appeared more likely to undergo the scans than those with better health status, according to study results in JAMA Network Open.
Researchers also observed racial and ethnic disparities in screening after taking health status into account, with Black individuals — who may benefit more from screening — less likely to report being screened than white individuals.
Rationale and methods
Differences in lung cancer screening completion and follow-up may be associated with lung cancer incidence and mortality rates among high-risk racial and ethnic populations, according to study background.
“We wanted to see if lung cancer screening is reaching those who stand to benefit the most from this potentially lifesaving test,” Alison S. Rustagi, MD, PhD, adjunct assistant professor in the department of medicine and a primary care physician in the division of general internal medicine at San Francisco Veterans Affairs Health Care System, told Healio.
Rustagi and colleagues conducted a cross-sectional, population-based study that included 14,550 adults (55.5% men; 89% white, 3% Black) aged between 55 and 79 years with a less than 30 pack-year smoking history and who reported themselves as current smokers or having quit within the last 15 years. They pooled data from Behavioral Risk Factor Surveillance System annual surveys conducted between 2017 and 2020.
Self-reported lung cancer screening within the previous year served as the primary outcome.
Key findings
Overall, 17% of individuals (95% CI, 15.1-18.9) reported undergoing lung cancer screening, including 12% (95% CI, 4.3-19.7%) of Black individuals and 17.5% (95% CI, 15.6-19.5) of white individuals.
Researchers reported an association of health status with lung cancer screening, with 468 individuals (25.2%; 95% CI, 20.6-29.9) in poor health undergoing screening compared with 96 individuals (7.6%; 95% CI, 5-10.3) in excellent health. In addition, those who reported difficulty climbing stairs appeared more likely to report undergoing lung cancer screening than those who did not have this limitation, researchers noted.
After adjusting for sociodemographic factors, functional status and comorbidities, researchers found self-reported health status remained associated with undergoing lung cancer screening (adjusted OR = 1.19 for each one-step decline in health; 95% CI, 1.03-1.38) and Black individuals had a 53% lower likelihood of undergoing lung cancer screening than white individuals (adjusted OR = 0.47; 95% CI, 0.24-0.9).
“Poor health was positively correlated with lung cancer screening — we defined health in a variety of ways, with consistent results,” Rustagi said. “We also observed significant disparities in the use of lung cancer screening between Blacks and whites after accounting for health status, with Black individuals approximately half as likely to have undergone lung cancer screening compared with white individuals of similar health.”
Study limitations included reliance on self-reported data and the low percentage of respondents who identified as Black, which likely limits the generalizability of the results, researchers wrote.
Implications
Together, these findings suggest that real-world use of lung cancer screening may fall short of the benefit measured in randomized trials, Rustagi said.
“Lung cancer screening is still underused, but as we are ramping up lung cancer screening, we need to be thoughtful of who is screened so that we can maximize the benefit. Two major questions remain, including how do we define being ‘healthy enough’ to likely benefit from lung cancer screening? National guidelines agree that health is essential to consider before lung cancer screening, but they disagree on what health metric is most appropriate to use. This creates confusion for providers and patients,” she said. “We also need to understand the root causes of racial/ethnic disparities in lung cancer screening so that we can begin to address them. We can save many more lives from lung cancer by doing this.”
For more information:
Alison S. Rustagi, MD, PhD, can be reached at San Francisco Veterans Affairs Health Care System, 4150 Clement St., Building 18, Room 118, San Francisco, CA 94122; email: alison.rustagi@ucsf.edu.
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