Breaking the Disparities: Addressing Underrepresentation in Lung Cancer Screening

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Lung cancer is a serious illness that affects many people worldwide. Unfortunately, lung cancer is often not diagnosed until it is too late, which means that many people do not have a good chance of getting better. This is a major concern, and it’s why we need to find better ways to catch lung cancer early. One way to do this is by doing a type of X-ray scan called a low-dose CT scan. This scan is special because it uses less radiation than traditional X-ray scans.

Two studies, the National Lung Screening Trial (NLST) and the Dutch-Belgian Lung Cancer Screening Trial (NELSON), have shown that an annual low-dose CT scan (LDCT) can help reduce the number of deaths from lung cancer among people who are at high risk. The Multicentric Italian Lung Detection (MILD) trial, however, did not find a significant difference in overall mortality between annual and biannual LDCT screening. The National Comprehensive Cancer Network (NCCN) and the US Preventative Services Task Force (USPSTF) have issued the following guidelines:

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Annual LDCT screening is recommended for high-risk adults, defined as those aged 55-74 with a 30 pack-year smoking history and less than 15 years since quitting, or those with a 20 pack-year smoking history and additional risk factors for lung cancer.

It’s important to note that the NLST study had low representation of minority populations, with 95% of participants being white and only 1.8% being Hispanic, which may have contributed to current disparities in lung cancer screening. Studies have shown that there are lower rates of low-dose CT implementation and screening eligibility in the African American population. A secondary analysis of the NLST study found that there was a greater reduction in lung cancer and all-cause mortality in African Americans, despite low participation (4.4% black vs 90.9% white). African Americans also have lower lung cancer screening eligibility rates despite higher incidences of the disease.

A recent study published in Frontiers in Oncology looked at how many Hispanic people would qualify for lung cancer screening before they were diagnosed with it. The researchers found that 52% of Hispanic people would qualify for screening according to the National Comprehensive Cancer Network (NCCN) guidelines, but only 20% would qualify according to the US Preventive Services Task Force (USPSTF) guidelines. The study also found that there is a big difference between how many Hispanic people and non-Hispanic people qualify for screening. 80% of Hispanic people would not qualify for screening according to the USPSTF guidelines, compared to 56% of non-Hispanic people. The study suggests that if the guidelines for screening were less strict, more people would be able to get screened earlier, and this could lead to earlier detection of lung cancer.

Conclusions of the study:
  1. Health equity for vulnerable populations can be improved by taking into account different risk factors and characteristics of different sex, race, and ethnicities
  2. Inclusive clinical trials and expanded inclusion criteria for LDCT (low-dose computed tomography) can help mitigate disparities
  3. Further research on the impact of social determinants of health on lung cancer risk and the creation of guidelines incorporating these factors can help close the gap in lung cancer screening disparities

Other problems of the lung cancer screening criteria

3 thoughts on “Breaking the Disparities: Addressing Underrepresentation in Lung Cancer Screening”

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