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

Literature Information ​

DOI10.3322/caac.21671
PMID34015860
JournalCA: a cancer journal for clinicians
Impact Factor232.4
JCR QuartileQ1
Publication Year2021
Times Cited65
Keywordsdisparities, lung cancer, lung cancer screening, racial minorities, socioeconomic status
Literature TypeJournal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Systematic Review
ISSN0007-9235
Pages299-314
Issue71(4)
AuthorsErnesto Sosa, Gail D'Souza, Aamna Akhtar, Melissa Sur, Kyra Love, Jeanette Duffels, Dan J Raz, Jae Y Kim, Virginia Sun, Loretta Erhunmwunsee

TL;DR ​

This study highlights significant disparities in lung cancer screening (LCS) among Black and socioeconomically disadvantaged individuals, identifying critical stages in the LCS pipeline where these groups miss out on potential benefits, ultimately contributing to higher mortality rates from nonsmall cell lung cancer (NSCLC). The authors advocate for further investigation into these inequities and suggest prospective trials to improve eligibility criteria and interventions aimed at enhancing utilization and follow-up care for underserved populations.

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disparities · lung cancer · lung cancer screening · racial minorities · socioeconomic status

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.

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Primary Questions Addressed ​

  1. What specific barriers do Black and socioeconomically disadvantaged individuals face in accessing lung cancer screening?
  2. How do perceptions of lung cancer screening differ among various racial and socioeconomic groups?
  3. What interventions have been proposed or implemented to improve lung cancer screening rates among marginalized populations?
  4. In what ways do eligibility criteria for lung cancer screening disproportionately affect racial minorities and low-income individuals?
  5. How can future research address the identified inequities in lung cancer screening to ensure better outcomes for all demographic groups?

Key Findings ​

Research Background and Purpose ​

Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer-related deaths globally. Lung cancer screening (LCS) has been shown to reduce NSCLC mortality rates; however, the lack of diversity in LCS studies may limit the applicability of these findings to marginalized populations who are at higher risk for NSCLC and experience worse outcomes. This study aims to identify sources of inequity in the LCS pipeline to address disparities in NSCLC outcomes among different racial and socioeconomic groups.

Main Methods/Materials/Experimental Design ​

The authors conducted a systematic review of studies published between January 1, 2010, and February 27, 2020. The following criteria were used for inclusion:

  1. Studies included participants aged 45 to 80 years who were current or former smokers.
  2. Studies were published in English.
  3. Studies were conducted in the United States.
  4. Studies discussed socioeconomic and race-based outcomes related to LCS.

A total of 3721 studies were screened, and 21 met the eligibility criteria. The selected studies were assessed for risk of bias and categorized into three main themes regarding disparities in LCS:

  • Theme 1: Eligibility
  • Theme 2: Utilization, perception, and utility
  • Theme 3: Postscreening behavior and care

The following flowchart illustrates the research design and methodology:

Mermaid diagram

Key Results and Findings ​

The findings from the eligible studies revealed significant disparities in LCS based on race and socioeconomic status. Key observations include:

ThemeFindings
EligibilityBlack and socioeconomically disadvantaged individuals face barriers to meeting eligibility criteria for LCS.
Utilization, Perception, and UtilityThere are differences in the perception of LCS benefits and utilization rates among different racial and socioeconomic groups.
Postscreening Behavior and CareDisparities exist in follow-up care and behavior after screening, contributing to increased mortality rates.

Main Conclusions/Significance/Innovation ​

The study highlights critical inequities in the LCS pipeline that adversely affect Black and socioeconomically disadvantaged individuals, leading to higher mortality rates from NSCLC. The authors emphasize the need for further investigation into these disparities and recommend prospective trials to evaluate eligibility criteria tailored for underserved populations. Additionally, they advocate for the development of targeted interventions to enhance utilization and improve follow-up care, which could significantly reduce disparities in LCS outcomes.

Research Limitations and Future Directions ​

The study has several limitations:

  • The review is limited to studies published in English, potentially omitting relevant research from non-English sources.
  • The assessment of risk of bias may not fully capture all methodological flaws in the included studies.

Future research directions include:

  • Expanding the scope to include non-English studies to gain a more comprehensive understanding of LCS disparities.
  • Conducting prospective trials to test interventions aimed at improving LCS accessibility and follow-up care for marginalized groups.
  • Investigating the underlying factors contributing to disparities in LCS eligibility and utilization to inform policy changes and public health initiatives.

References ​

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Literatures Citing This Work ​

  1. Evaluation of tumor microenvironmental immune regulation and prognostic in lung adenocarcinoma from the perspective of purinergic receptor P2Y13. - Jiangtao Wang;Weiwei Shi;Yandong Miao;Jian Gan;Quanlin Guan;Juntao Ran - Bioengineered (2021)
  2. A Lung Cancer Screening Education Program Impacts both Referral Rates and Provider and Medical Assistant Knowledge at Two Federally Qualified Health Centers. - Aamna Akhtar;Ernesto Sosa;Samuel Castro;Melissa Sur;Vanessa Lozano;Gail D'Souza;Sophia Yeung;Jonjon Macalintal;Meghna Patel;Xiaoke Zou;Pei-Chi Wu;Ellen Silver;Jossie Sandoval;Stacy W Gray;Karen L Reckamp;Jae Y Kim;Virginia Sun;Dan J Raz;Loretta Erhunmwunsee - Clinical lung cancer (2022)
  3. Socio-Economic Inequalities in Lung Cancer Outcomes: An Overview of Systematic Reviews. - Daniel Redondo-Sánchez;Dafina Petrova;Miguel Rodríguez-Barranco;Pablo Fernández-Navarro;José Juan Jiménez-Moleón;Maria-José Sánchez - Cancers (2022)
  4. Tumor Immune Microenvironment and Immunotherapy in Brain Metastasis From Non-Small Cell Lung Cancer. - Yuchang Wang;Rui Chen;Yue Wa;Shikuan Ding;Yijian Yang;Junbo Liao;Lei Tong;Gelei Xiao - Frontiers in immunology (2022)
  5. Likelihood of Lung Cancer Screening by Poor Health Status and Race and Ethnicity in US Adults, 2017 to 2020. - Alison S Rustagi;Amy L Byers;Salomeh Keyhani - JAMA network open (2022)
  6. A novel classification method for NSCLC based on the background interaction network and the edge-perturbation matrix. - Yuan Tian;Caiqing Zhang;Wanru Ma;Alan Huang;Mei Tian;Junyan Zhao;Qi Dang;Yuping Sun - Aging (2022)
  7. Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend. - Samantha Groves;Grace McCutchan;Samantha L Quaife;Rachael L Murray;Jamie S Ostroff;Kate Brain;Philip A J Crosbie;Janelle Yorke;David Baldwin;John K Field;Lorna McWilliams - Health expectations : an international journal of public participation in health care and health policy (2022)
  8. FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy. - Enola Proctor;Alex T Ramsey;Lisa Saldana;Thomas M Maddox;David A Chambers;Ross C Brownson - Global implementation research and applications (2022)
  9. Health Economics Research in Cancer Screening: Research Opportunities, Challenges, and Future Directions. - Ya-Chen Tina Shih;Lindsay M Sabik;Natasha K Stout;Michael T Halpern;Joseph Lipscomb;Scott Ramsey;Debra P Ritzwoller - Journal of the National Cancer Institute. Monographs (2022)
  10. Evidence of Racial Disparities in the Lung Cancer Screening Process: a Systematic Review and Meta-Analysis. - Yukiko Kunitomo;Brett Bade;Craig G Gunderson;Kathleen M Akgün;Alexandria Brackett;Lynn Tanoue;Lori A Bastian - Journal of general internal medicine (2022)

... (55 more literatures)

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