Since the expansion of lung cancer screening guidelines in 2021, more individuals have gained access to screenings, yet significant disparities persist, particularly among underserved populations, according to a recent study led by researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
Progress and Persistent Barriers
“The updated guidelines have increased lung cancer screenings overall, even amid declines in cancer screenings during the COVID-19 pandemic,” said Tracy E. Crane, Ph.D., R.D.N., co-leader of Sylvester’s Cancer Control Research Program. “However, disparities remain, highlighting the need to address structural barriers affecting rural and underserved communities.” Crane is the senior author of the study, published in JAMA Oncology on March 20.
Lung cancer remains the leading cause of cancer-related deaths in the United States. Early detection through low-dose computed tomography (CT) can significantly improve survival rates. In 2013, the U.S. Preventive Services Task Force (USPSTF) introduced lung cancer screening guidelines. The 2021 update lowered the starting age from 55 to 50 and reduced the required smoking history from 30 to 20 pack-years, expanding eligibility.
Screening Uptake and Disparities
First author LaShae D. Rolle, M.P.H., C.P.H., a Sylvester doctoral research fellow, analyzed data from a nationally representative CDC survey. Findings revealed that before the guideline revisions, only 15.43% of high-risk individuals were up to date with screenings. Following the changes, this increased to 47.08%—a notable improvement but still less than half of those eligible.
Uninsured individuals, those without a primary care provider, and rural residents were least likely to undergo screening. Limited awareness and logistical hurdles contribute to these disparities.
Addressing Barriers to Care
A key obstacle is the requirement for a referral, which patients without primary care providers may struggle to obtain. Additionally, many remain unaware of their eligibility for screening. Financial concerns also play a role—97% of screenings are covered by insurance, but for uninsured individuals, costs can be prohibitive, including additional expenses for follow-up tests.
Despite financial constraints, free or low-cost screening programs exist through state and nonprofit initiatives. However, annual screenings and follow-up tests add to the overall financial burden.
“Many people believe they don’t have cancer and prioritize other expenses over screening,” Rolle noted. “As a cancer survivor, I understand how easy it is to delay a screening, especially for those choosing between basic needs and medical care.”
For rural residents, access remains a challenge, with some needing to travel hundreds of miles to screening facilities. Mobile screening units provide a solution but come with high operational costs, sometimes reaching $2 million.
Closing the Screening Gap
To address disparities, Sylvester Comprehensive Cancer Center employs community outreach strategies. “We identify high-risk areas and deploy our Game Changer Bus to educate and counsel the public on lung cancer screening,” said Estelamari Rodriguez, M.D., M.P.H., Sylvester’s associate director of community outreach for thoracic oncology.
Other solutions include patient navigators who assist with education, scheduling, and transportation. Community partnerships with churches, local organizations, and trusted health workers also play a critical role in fostering awareness and reducing fear and mistrust.
“Engaging trusted local figures helps break down barriers and provide culturally tailored education,” added Gilberto Lopes, M.D., Sylvester’s chief of medical oncology.
For Rolle, the mission is personal. “Early detection saved my life. I hope others take advantage of screening opportunities to catch cancer early and improve their outcomes.”
Related topics:
- Fast-Track Weight Loss: Early Medication Use Doubles Results
- How Lab-Grown Embryo Models Advance Health Research
- Benadryl Liquid Elixir Recall: Potential Poisoning Risk for Children Leads to Urgent Action
