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Backhus LM, Chang CF, Sakoda LC, Chambers SR, Henderson LM, Henschke CI, Hollenbeck GJ, Jacobson FL, Martin LW, Proctor ED, Schiller JH, Siegfried JM, Wisnivesky JP, Wolf AS, Jemal A, Kelly K, Sandler KL, Watkins PN, Smith RA, Rivera MP. The American Cancer Society National Lung Cancer Roundtable strategic plan: Lung cancer in women. Cancer 2024. [PMID: 39302237 DOI: 10.1002/cncr.35083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Lung cancer in women is a modern epidemic and represents a global health crisis. Cigarette smoking remains the most important risk factor for lung cancer in all patients and, among women globally, rates of smoking continue to increase. Although some data exist supporting sex-based differences across the continuum of lung cancer, there is currently a dearth of research exploring the differences in risk, biology, and treatment outcomes in women. Consequently, the American Cancer Society National Lung Cancer Roundtable recognizes the urgent need to promote awareness and future research that will close the knowledge gaps regarding lung cancer in women. To this end, the American Cancer Society National Lung Cancer Roundtable Task Group on Lung Cancer in Women convened a summit undertaking the following to: (1) summarize existing evidence and identify knowledge gaps surrounding the epidemiology, risk factors, biologic differences, and outcomes of lung cancer in women; (2) develop and prioritize research topics and questions that address research gaps and advance knowledge to improve quality of care of lung cancer in women; and (3) propose strategies for future research. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer mortality in women, and, despite comparatively lower exposures to occupational and environmental carcinogens compared with men, disproportionately higher lung cancer rates in women who ever smoked and women who never smoked call for increased awareness and research that will close the knowledge gaps regarding lung cancer in women.
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Affiliation(s)
- Leah M Backhus
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University, Stanford, California, USA
| | - Ching-Fei Chang
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Shonta R Chambers
- Department of Health Equity, Patient Advocate Foundation, Hampton, Virginia, USA
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Claudia I Henschke
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA
| | | | - Francine L Jacobson
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Elridge D Proctor
- Government Affairs, GO2 Foundation for Lung Cancer, Washington, District of Columbia, USA
| | | | - Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Juan P Wisnivesky
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea S Wolf
- Department Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Karen Kelly
- Department of Internal Medicine, Division of Hematology and Oncology, The University of California at Davis, Sacramento, California, USA
| | - Kim L Sandler
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Robert A Smith
- Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - M Patricia Rivera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Wilmot Cancer Institute, The University of Rochester Medical Center, Rochester, New York, USA
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Kazerooni EA, Wood DE, Rosenthal LS, Smith RA. The American Cancer Society National Lung Cancer Roundtable strategic plan: Introduction. Cancer 2024. [PMID: 39302215 DOI: 10.1002/cncr.35385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Lung cancer is the leading cause of cancer death in the United States and across the world. The American Cancer Society National Lung Cancer Roundtable (ACS NLCRT) was established in 2017 as a consortium of public, private, and voluntary organizations with a mission to lower the impact of lung cancer via prevention, early detection, and optimal therapy. The ACS NLCRT supports a comprehensive scope of work that covers the lung cancer continuum, from risk reduction, tobacco prevention and control, and early detection (screening and incidental lung nodule management) to guideline-based staging, biomarker testing, treatment, and survivorship and overarching issues such as stigma and nihilism, health equity, and tactical approaches such as state coalition efforts and policy initiatives. Applying a multidimensional and multisector approach, over 220 public, private, and government agency member organizations and 250 volunteer experts, patients, and caregiver advocate representatives collaborate to address challenges across the lung cancer continuum by catalyzing action to conceive, build, and strengthen innovative solutions. The wide-ranging membership allows the ACS NLCRT to harness the collective power and expertise of the entire lung cancer community by connecting leaders, communities, and systems to improve equity and access. These national, state, and local relationships provide partnerships for the dissemination of ACS NLCRT-developed tools and resources. This article describes the ACS NLCRT and introduces the series of accompanying and future articles that together make up the ACS NLCRT strategic plan, which provides a roadmap for future research, investment, and collaboration to reduce lung cancer mortality and lung cancer-related stigma and enhance survivorship.
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Affiliation(s)
- Ella A Kazerooni
- Departments of Radiology and Internal Medicine, Michigan Medicine and University of Michigan, Ann Arbor, Michigan, USA
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Lauren S Rosenthal
- Patient Support Department, American Cancer Society National Lung Cancer Roundtable, American Cancer Society, Atlanta, Georgia, USA
| | - Robert A Smith
- American Cancer Society Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
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Welch AC, Gorden JA, Mooney SJ, Wilshire CL, Zeliadt SB. Understanding Washington State's Low Uptake of Lung Cancer Screening in Two Steps: A Geospatial Analysis of Patient Travel Time and Health Care Availability of Imaging Sites. Chest 2024; 166:622-631. [PMID: 38815622 DOI: 10.1016/j.chest.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Early detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites, must also be considered. RESEARCH QUESTION What proportion of the eligible population for LCS has access to LCS facilities in Washington State? STUDY DESIGN AND METHODS We used the enhanced two-step floating catchment area (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR)-accredited screening facility site to estimate the capacity of each site to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios were compared with the 2010 Rural-Urban Commuting Area codes and area deprivation index quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access. RESULTS A total of 549 radiologic technologists were identified across the 95 ACR-accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated, and areas with greater socioeconomic disadvantage were modestly correlated, with lower access. INTERPRETATION Rural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.
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Affiliation(s)
- Allison C Welch
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Jed A Gorden
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Candice L Wilshire
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Steven B Zeliadt
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA.
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Adler DH, Wood N, Fiscella K, Rivera MP, Hernandez-Romero B, Chamberlin S, Abar B. Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study. J Emerg Med 2024; 67:e164-e176. [PMID: 38839453 DOI: 10.1016/j.jemermed.2024.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/23/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in the United States. Lung cancer screening (LCS) decreases lung cancer mortality. Emergency department (ED) patients are at disproportionately high risk for lung cancer. The ED, therefore, is an optimal environment for interventions to promote LCS. OBJECTIVES Demonstrate the operational feasibility of identifying ED patients in need of LCS, referring them to LCS services, deploying a text message intervention to promote LCS, and conducting follow-up to determine LCS uptake. METHODS We conducted a randomized clinical trial to determine the feasibility and provide estimates of the preliminary efficacies of 1) basic referral for LCS and 2) basic referral plus a text messaging intervention, grounded in behavioral change theory, to promote uptake of LCS among ED patients. Participants aged 50 to 80, identified as eligible for LCS, were randomized to study arms and followed up at 150 days to assess interval LCS uptake (primary outcome), barriers to screening, and perceptions of the study interventions. RESULTS A total of 303 patients were surveyed, with 198 identified as eligible for LCS and subsequently randomized. Results indicated that 24% of participants with follow-up data received LCS (11% of the total randomized sample). Rates of screening at follow-up were similar across study arms. The intervention significantly improved normative perceptions of LCS (p = 0.015; Cohen's d = 0.45). CONCLUSION This pilot study demonstrates the feasibility of ED-based interventions to increase uptake of LCS among ED patients. A scalable ED-based intervention that increases LCS uptake could reduce lung cancer mortality.
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Affiliation(s)
- David H Adler
- Department of Emergency Medicine, University of Rochester, Rochester, New York.
| | - Nancy Wood
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, New York
| | - M Patricia Rivera
- Department of Medicine, University of Rochester, Rochester, New York
| | | | - Sydney Chamberlin
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Beau Abar
- Department of Emergency Medicine, University of Rochester, Rochester, New York
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Chang AEB, Potter AL, Yang CFJ, Sequist LV. Early Detection and Interception of Lung Cancer. Hematol Oncol Clin North Am 2024; 38:755-770. [PMID: 38724286 DOI: 10.1016/j.hoc.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Recent advances in lung cancer treatment have led to dramatic improvements in 5-year survival rates. And yet, lung cancer remains the leading cause of cancer-related mortality, in large part, because it is often diagnosed at an advanced stage, when cure is no longer possible. Lung cancer screening (LCS) is essential for intercepting the disease at an earlier stage. Unfortunately, LCS has been poorly adopted in the United States, with less than 5% of eligible patients being screened nationally. This article will describe the data supporting LCS, the obstacles to LCS implementation, and the promising opportunities that lie ahead.
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Affiliation(s)
- Allison E B Chang
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Department of Hematology/Oncology, Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chi-Fu Jeffrey Yang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lecia V Sequist
- Department of Medicine, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Semprini J, Gadag K, Williams G, Muldrow A, Zahnd WE. Rural-Urban Cancer Incidence and Trends in the United States, 2000 to 2019. Cancer Epidemiol Biomarkers Prev 2024; 33:1012-1022. [PMID: 38801414 DOI: 10.1158/1055-9965.epi-24-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Despite consistent improvements in cancer prevention and care, rural and urban disparities in cancer incidence persist in the United States. Our objective was to further examine rural-urban differences in cancer incidence and trends. METHODS We used the North American Association of Central Cancer Registries dataset to investigate rural-urban differences in 5-year age-adjusted cancer incidence (2015-2019) and trends (2000-2019), also examining differences by region, sex, race/ethnicity, and tumor site. Age-adjusted rates were calculated using SEER∗Stat 8.4.1, and trend analysis was done using Joinpoint, reporting annual percent changes (APC). RESULTS We observed higher all cancer combined 5-year incidence rates in rural areas (457.6 per 100,000) compared with urban areas (447.9), with the largest rural-urban difference in the South (464.4 vs. 449.3). Rural populations also exhibited higher rates of tobacco-associated, human papillomavirus-associated, and colorectal cancers, including early-onset cancers. Tobacco-associated cancer incidence trends widened between rural and urban from 2000 to 2019, with significant, but varying, decreases in urban areas throughout the study period, whereas significant rural decreases only occurred between 2016 and 2019 (APC = -0.96). Human papillomavirus-associated cancer rates increased in both populations until recently with urban rates plateauing whereas rural rates continued to increase (e.g., APC = 1.56, 2002-2019). CONCLUSIONS Rural populations had higher overall cancer incidence rates and higher rates of cancers with preventive opportunities compared with urban populations. Improvements in these rates were typically slower in rural populations. IMPACT Our findings underscore the complex nature of rural-urban disparities, emphasizing the need for targeted interventions and policies to reduce disparities and achieve equitable health outcomes.
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Affiliation(s)
- Jason Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Khyathi Gadag
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Gawain Williams
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Aniyah Muldrow
- Department of Sociology, School of Arts and Sciences, Rutgers University, New Brunswick, New Jersey
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
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Franks JA, Davis ES, Bhatia S, Kenzik KM. Contribution of County Characteristics to Disparities in Rural Mortality After Cancer Diagnosis. Am J Prev Med 2024; 67:79-89. [PMID: 38342479 PMCID: PMC11193638 DOI: 10.1016/j.amepre.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Rural disparities in cancer outcomes have been widely evaluated, but limited evidence is available to describe what characteristics of rural environments contribute to the increased risk of poor outcomes. Therefore, this manuscript sought to assess the mediating effects of county characteristics on the relationship between urban/rural status and mortality among patients with cancer, characterize county profiles, and determine at-risk county profiles alongside rural settings. METHODS Patients diagnosed with cancer between 2000 and 2016 were assessed using Surveillance, Epidemiology and End Results data linked to the 2010 Rural-Urban Commuting Codes and 2010 County Health Rankings. There were 757,655 patients representing 596 counties (of 3,143 in the U.S.) and 12 states. Mediation analyses, conducted in 2023, estimated the direct contribution of rurality to 5-year all-cause survival and the contribution of the rural effect indirectly through County Health Ranking domains. Latent class analysis and survival models identified county groupings and estimated the hazard of mortality associated with class membership. RESULTS Rankings for premature death, clinical care, and physical environment resulted in rural patients having 17.9%-20.2% less survival time than urban patients. Of this, 4.1%-12.6% of the total excess risk was mediated by these characteristics. Patients living in rural and high-risk county classes saw higher all-cause mortality than those in urban lower-risk counties (hazard ratio=1.04, 95% CI=1.01, 1.08 and 1.07, 95% CI=1.03, 1.11). CONCLUSIONS Counties with poorer health rankings had increased mortality risks regardless of rurality; however, the poor rankings, notably health behaviors and social and economic factors, elevated the risk for rural counties.
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Affiliation(s)
- Jeffrey A Franks
- Division of Hematology and Oncology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth S Davis
- Department of Surgery, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Kelly M Kenzik
- Department of Surgery, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts; Slone Epidemiology Center, Boston University, Boston, Massachusetts.
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Kearney L, Nguyen T, Steiling K. Disparities across the continuum of lung cancer care: a review of recent literature. Curr Opin Pulm Med 2024; 30:359-367. [PMID: 38411202 DOI: 10.1097/mcp.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Lung cancer remains the leading cause of cancer mortality worldwide. Health disparities have long been noted in lung cancer incidence and survival and persist across the continuum of care. Understanding the gaps in care that arise from disparities in lung cancer risk, screening, treatment, and survivorship are essential to guiding efforts to achieve equitable care. RECENT FINDINGS Recent literature continues to show that Black people, women, and people who experience socioeconomic disadvantage or live in rural areas experience disparities throughout the spectrum of lung cancer care. Contributing factors include structural racism, lower education level and health literacy, insurance type, healthcare facility accessibility, inhaled carcinogen exposure, and unmet social needs. Promising strategies to improve lung cancer care equity include policy to reduce exposure to tobacco smoke and harmful pollutants, more inclusive lung cancer screening eligibility criteria, improved access and patient navigation in lung cancer screening, diagnosis and treatment, more deliberate offering of appropriate surgical and medical treatments, and improved availability of survivorship and palliative care. SUMMARY Given ongoing disparities in lung cancer care, research to determine best practices for narrowing these gaps and to guide policy change are an essential focus of future lung cancer research.
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Affiliation(s)
- Lauren Kearney
- Section of Pulmonary, Allergy, and Critical Care Medicine. Boston University Chobanian and Avedisian School of Medicine
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System
| | - Tatyana Nguyen
- Department of Medicine. Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Katrina Steiling
- Section of Pulmonary, Allergy, and Critical Care Medicine. Boston University Chobanian and Avedisian School of Medicine
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García MC, Rossen LM, Matthews K, Guy G, Trivers KF, Thomas CC, Schieb L, Iademarco MF. Preventable Premature Deaths from the Five Leading Causes of Death in Nonmetropolitan and Metropolitan Counties, United States, 2010-2022. MORBIDITY AND MORTALITY WEEKLY REPORT. SURVEILLANCE SUMMARIES (WASHINGTON, D.C. : 2002) 2024; 73:1-11. [PMID: 38687830 PMCID: PMC11065459 DOI: 10.15585/mmwr.ss7302a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Problem/Condition A 2019 report quantified the higher percentage of potentially excess (preventable) deaths in U.S. nonmetropolitan areas compared with metropolitan areas during 2010-2017. In that report, CDC compared national, regional, and state estimates of preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties during 2010-2017. This report provides estimates of preventable premature deaths for additional years (2010-2022). Period Covered 2010-2022. Description of System Mortality data for U.S. residents from the National Vital Statistics System were used to calculate preventable premature deaths from the five leading causes of death among persons aged <80 years. CDC's National Center for Health Statistics urban-rural classification scheme for counties was used to categorize the deaths according to the urban-rural county classification level of the decedent's county of residence (1: large central metropolitan [most urban], 2: large fringe metropolitan, 3: medium metropolitan, 4: small metropolitan, 5: micropolitan, and 6: noncore [most rural]). Preventable premature deaths were defined as deaths among persons aged <80 years that exceeded the number expected if the death rates for each cause in all states were equivalent to those in the benchmark states (i.e., the three states with the lowest rates). Preventable premature deaths were calculated separately for the six urban-rural county categories nationally, the 10 U.S. Department of Health and Human Services public health regions, and the 50 states and the District of Columbia. Results During 2010-2022, the percentage of preventable premature deaths among persons aged <80 years in the United States increased for unintentional injury (e.g., unintentional poisoning including drug overdose, unintentional motor vehicle traffic crash, unintentional drowning, and unintentional fall) and stroke, decreased for cancer and chronic lower respiratory disease (CLRD), and remained stable for heart disease. The percentages of preventable premature deaths from the five leading causes of death were higher in rural counties in all years during 2010-2022. When assessed by the six urban-rural county classifications, percentages of preventable premature deaths in the most rural counties (noncore) were consistently higher than in the most urban counties (large central metropolitan and fringe metropolitan) for the five leading causes of death during the study period.During 2010-2022, preventable premature deaths from heart disease increased most in noncore (+9.5%) and micropolitan counties (+9.1%) and decreased most in large central metropolitan counties (-10.2%). Preventable premature deaths from cancer decreased in all county categories, with the largest decreases in large central metropolitan and large fringe metropolitan counties (-100.0%; benchmark achieved in both county categories in 2019). In all county categories, preventable premature deaths from unintentional injury increased, with the largest increases occurring in large central metropolitan (+147.5%) and large fringe metropolitan (+97.5%) counties. Preventable premature deaths from CLRD decreased most in large central metropolitan counties where the benchmark was achieved in 2019 and increased slightly in noncore counties (+0.8%). In all county categories, preventable premature deaths from stroke decreased from 2010 to 2013, remained constant from 2013 to 2019, and then increased in 2020 at the start of the COVID-19 pandemic. Percentages of preventable premature deaths varied across states by urban-rural county classification during 2010-2022. Interpretation During 2010-2022, nonmetropolitan counties had higher percentages of preventable premature deaths from the five leading causes of death than did metropolitan counties nationwide, across public health regions, and in most states. The gap between the most rural and most urban counties for preventable premature deaths increased during 2010-2022 for four causes of death (cancer, heart disease, CLRD, and stroke) and decreased for unintentional injury. Urban and suburban counties (large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan) experienced increases in preventable premature deaths from unintentional injury during 2010-2022, leading to a narrower gap between the already high (approximately 69% in 2022) percentage of preventable premature deaths in noncore and micropolitan counties. Sharp increases in preventable premature deaths from unintentional injury, heart disease, and stroke were observed in 2020, whereas preventable premature deaths from CLRD and cancer continued to decline. CLRD deaths decreased during 2017-2020 but increased in 2022. An increase in the percentage of preventable premature deaths for multiple leading causes of death was observed in 2020 and was likely associated with COVID-19-related conditions that contributed to increased mortality from heart disease and stroke. Public Health Action Routine tracking of preventable premature deaths based on urban-rural county classification might enable public health departments to identify and monitor geographic disparities in health outcomes. These disparities might be related to different levels of access to health care, social determinants of health, and other risk factors. Identifying areas with a high prevalence of potentially preventable mortality might be informative for interventions.
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Kratzer TB, Bandi P, Freedman ND, Smith RA, Travis WD, Jemal A, Siegel RL. Lung cancer statistics, 2023. Cancer 2024; 130:1330-1348. [PMID: 38279776 DOI: 10.1002/cncr.35128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 01/28/2024]
Abstract
Despite decades of declining mortality rates, lung cancer remains the leading cause of cancer death in the United States. This article examines lung cancer incidence, stage at diagnosis, survival, and mortality using population-based data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries. Over the past 5 years, declines in lung cancer mortality became considerably greater than declines in incidence among men (5.0% vs. 2.6% annually) and women (4.3% vs. 1.1% annually), reflecting absolute gains in 2-year relative survival of 1.4% annually. Improved outcomes likely reflect advances in treatment, increased access to care through the Patient Protection and Affordable Care Act, and earlier stage diagnosis; for example, compared with a 4.6% annual decrease for distant-stage disease incidence during 2013-2019, the rate for localized-stage disease rose by 3.6% annually. Localized disease incidence increased more steeply in states with the highest lung cancer screening prevalence (by 3%-5% annually) than in those with the lowest (by 1%-2% annually). Despite progress, disparities remain. For example, Native Americans have the highest incidence and the slowest decline (less than 1% annually among men and stagnant rates among women) of any group. In addition, mortality rates in Mississippi and Kentucky are two to three times higher than in most western states, largely because of elevated historic smoking prevalence that remains. Racial and geographic inequalities highlight longstanding opportunities for more concerted tobacco-control efforts targeted at high-risk populations, including improved access to smoking-cessation treatments and lung cancer screening, as well as state-of-the-art treatment.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Neal D Freedman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert A Smith
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - William D Travis
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Aruma JF, Hearn M, Bernacchi V, Moss JL. Examining the roles of travel distance, medical mistrust, and cancer fatalism in the uptake of clinical cancer prevention among women in rural and urban US communities: A secondary data analysis. Prev Med Rep 2024; 38:102611. [PMID: 38375162 PMCID: PMC10874844 DOI: 10.1016/j.pmedr.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Rural adults are less likely to receive cancer screening than urban adults, likely due to systematic differences in community- and individual-level factors. The purpose of this study was to analyze the relative contributions of rurality, travel time, medical mistrust, and cancer fatalism in explaining uptake of clinical cancer prevention services. Methods We conducted a secondary data analysis of 2019-2020 survey data from women, ages 45-65, in rural and urban counties in central Pennsylvania, examining rurality, travel time to a primary care provider, medical mistrust, and cancer fatalism, as well as uptake of guideline-recommended colorectal cancer screening, cervical cancer screening, and preventive check-up. Final models used multivariable logistic regression to assess the relationships among study variables, controlling for participant demographics. Results Among 474 participants, 48.9 % resided in rural counties. Most participants had received clinical cancer prevention services (colorectal cancer screening: 55.4 %; cervical cancer screening: 82.8 %; preventive check-up in the last year: 75.4 %). Uptake of services was less common among participants with higher medical mistrust (colorectal cancer screening: adjusted odds ratio [aOR] = 0.87, 95 % confidence interval [CI] = 0.76-1.00; cervical cancer screening: aOR = 0.79, 95 % CI = 0.63-1.00; last-year check-up: aOR = 0.74, 95 % CI = 0.63-0.88). Conclusions Patient attitudes, particularly medical mistrust, may contribute to rural/urban disparities in clinical cancer prevention among women. Community- and individual-level interventions are needed to improve cancer outcomes in rural areas.
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Affiliation(s)
- Jane-Frances Aruma
- Penn State College of Medicine, The Pennsylvania State University, State College, PA, USA
| | - Madison Hearn
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Veronica Bernacchi
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Jennifer L. Moss
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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12
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Brock BA, Mir H, Flenaugh EL, Oprea-Ilies G, Singh R, Singh S. Social and Biological Determinants in Lung Cancer Disparity. Cancers (Basel) 2024; 16:612. [PMID: 38339362 PMCID: PMC10854636 DOI: 10.3390/cancers16030612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Lung cancer remains a leading cause of death in the United States and globally, despite progress in treatment and screening efforts. While mortality rates have decreased in recent years, long-term survival of patients with lung cancer continues to be a challenge. Notably, African American (AA) men experience significant disparities in lung cancer compared to European Americans (EA) in terms of incidence, treatment, and survival. Previous studies have explored factors such as smoking patterns and complex social determinants, including socioeconomic status, personal beliefs, and systemic racism, indicating their role in these disparities. In addition to social factors, emerging evidence points to variations in tumor biology, immunity, and comorbid conditions contributing to racial disparities in this disease. This review emphasizes differences in smoking patterns, screening, and early detection and the intricate interplay of social, biological, and environmental conditions that make African Americans more susceptible to developing lung cancer and experiencing poorer outcomes.
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Affiliation(s)
- Briana A. Brock
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Hina Mir
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Eric L. Flenaugh
- Division of Pulmonary Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| | - Gabriela Oprea-Ilies
- Department of Pathology & Laboratory Medicine, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Rajesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
| | - Shailesh Singh
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA 30310, USA; (B.A.B.); (H.M.); (R.S.)
- Cell and Molecular Biology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA 30322, USA
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13
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Romo E, Stopka TJ, Jesdale BM, Wang B, Mazor KM, Friedmann PD. Association of spatial proximity to fixed-site syringe services programs with HCV serostatus and injection equipment sharing practices among people who inject drugs in rural New England, United States. Harm Reduct J 2024; 21:23. [PMID: 38282000 PMCID: PMC10822149 DOI: 10.1186/s12954-023-00916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). METHODS Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. RESULTS Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). CONCLUSIONS Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
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Affiliation(s)
- Eric Romo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Bill M Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Chan Medical, Worcester, MA, USA
| | - Peter D Friedmann
- Office of Research, University of MA Chan Medical School - Baystate, Springfield, MA, USA
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14
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Wolf AMD, Oeffinger KC, Shih TYC, Walter LC, Church TR, Fontham ETH, Elkin EB, Etzioni RD, Guerra CE, Perkins RB, Kondo KK, Kratzer TB, Manassaram-Baptiste D, Dahut WL, Smith RA. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin 2024; 74:50-81. [PMID: 37909877 DOI: 10.3322/caac.21811] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.
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Affiliation(s)
- Andrew M D Wolf
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine and Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina, USA
| | - Tina Ya-Chen Shih
- David Geffen School of Medicine and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Louise C Walter
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Timothy R Church
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth T H Fontham
- Health Sciences Center, School of Public Health, Louisiana State University, New Orleans, Louisiana, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ruth D Etzioni
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca B Perkins
- Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Karli K Kondo
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tyler B Kratzer
- Cancer Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | | | | | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
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15
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Lam S, Bai C, Baldwin DR, Chen Y, Connolly C, de Koning H, Heuvelmans MA, Hu P, Kazerooni EA, Lancaster HL, Langs G, McWilliams A, Osarogiagbon RU, Oudkerk M, Peters M, Robbins HA, Sahar L, Smith RA, Triphuridet N, Field J. Current and Future Perspectives on Computed Tomography Screening for Lung Cancer: A Roadmap From 2023 to 2027 From the International Association for the Study of Lung Cancer. J Thorac Oncol 2024; 19:36-51. [PMID: 37487906 PMCID: PMC11253723 DOI: 10.1016/j.jtho.2023.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
Low-dose computed tomography (LDCT) screening for lung cancer substantially reduces mortality from lung cancer, as revealed in randomized controlled trials and meta-analyses. This review is based on the ninth CT screening symposium of the International Association for the Study of Lung Cancer, which focuses on the major themes pertinent to the successful global implementation of LDCT screening and develops a strategy to further the implementation of lung cancer screening globally. These recommendations provide a 5-year roadmap to advance the implementation of LDCT screening globally, including the following: (1) establish universal screening program quality indicators; (2) establish evidence-based criteria to identify individuals who have never smoked but are at high-risk of developing lung cancer; (3) develop recommendations for incidentally detected lung nodule tracking and management protocols to complement programmatic lung cancer screening; (4) Integrate artificial intelligence and biomarkers to increase the prediction of malignancy in suspicious CT screen-detected lesions; and (5) standardize high-quality performance artificial intelligence protocols that lead to substantial reductions in costs, resource utilization and radiologist reporting time; (6) personalize CT screening intervals on the basis of an individual's lung cancer risk; (7) develop evidence to support clinical management and cost-effectiveness of other identified abnormalities on a lung cancer screening CT; (8) develop publicly accessible, easy-to-use geospatial tools to plan and monitor equitable access to screening services; and (9) establish a global shared education resource for lung cancer screening CT to ensure high-quality reading and reporting.
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Affiliation(s)
- Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chunxue Bai
- Shanghai Respiratory Research Institute and Chinese Alliance Against Cancer, Shanghai, People's Republic of China
| | - David R Baldwin
- Nottingham University Hospitals National Health Services (NHS) Trust, Nottingham, United Kingdom
| | - Yan Chen
- Digital Screening, Faculty of Medicine & Health Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Harry de Koning
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Ping Hu
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Harriet L Lancaster
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Georg Langs
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australia University of Western Australia, Nedlands, Western Australia
| | | | - Matthijs Oudkerk
- Center for Medical Imaging and The Institute for Diagnostic Accuracy, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Matthew Peters
- Woolcock Institute of Respiratory Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Liora Sahar
- Data Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia
| | | | - John Field
- Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
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16
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Washington T, Taylor A, Kieran K. Just Get in Line: Rural-Urban Differences in Access to Pediatric Renal-Bladder Ultrasounds. J Surg Res 2024; 293:511-516. [PMID: 37827029 DOI: 10.1016/j.jss.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Health-care disparities in rural and underserved areas may be exacerbated by the pandemic, personnel challenges, and supply chain limitations. This study aimed to quantify current variation in rural and urban pediatric renal ultrasound availability. METHODS We identified all hospitals statewide and contacted radiology departments posing as a parent trying to schedule an appointment for a routine pediatric renal-bladder ultrasound. Intervals between day of contact and first available appointment were compared between rural and urban institutions. RESULTS We were able to contact 42/48 (87.5%) rural hospitals, and 20/39 (51.3%) urban hospitals. Scheduling could not be completed in 5 rural and 7 urban hospitals. The median wait time for the 37 remaining rural and 13 remaining urban hospitals was similar: 7 (range: 0-21) days in rural hospitals and 6 (range: 0-17) days in urban hospitals (P = 0.81). If contact was made, the likelihood of scheduling within 7 d was similar in rural and urban areas (odds ratio [OR] = 0.23; 95% confidence interval [CI] 0.03-1.97; P = 0.18). However, patients were much more likely to have a completed call at a rural hospital (OR = 6.65; 95% CI: 2.3-19.2; P = 0.0005), and so in reality, patients were 2.89 times as likely to be able to schedule an renal-bladder ultrasound within 7 d at a rural compared with an urban institution (95% CI: 1.19-7.03; P = 0.019). CONCLUSIONS While access to pediatric renal sonograms was similar within a week at rural and urban institutions once telephone contact was made, it was significantly more difficult to schedule appointments at urban institutions.
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Affiliation(s)
- Taylor Washington
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Amy Taylor
- Division of Urology, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kieran
- Division of Urology, Seattle Children's Hospital, Seattle, Washington; Department of Urology, University of Washington, Seattle, Washington.
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17
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Bilenduke E, Anderson S, Brenner A, Currier J, Eberth JM, King J, Land SR, Risendal BC, Shannon J, Siegel LN, Wangen M, Waters AR, Zahnd WE, Studts JL. Equitable implementation of lung cancer screening: avoiding its potential to mirror existing inequities among people who use tobacco. Cancer Causes Control 2023; 34:209-216. [PMID: 37713024 PMCID: PMC10689540 DOI: 10.1007/s10552-023-01790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Lung cancer is the leading cause of cancer death, but the advent of lung cancer screening using low-dose computed tomography offers a tremendous opportunity to improve lung cancer outcomes. Unfortunately, implementation of lung cancer screening has been hampered by substantial barriers and remains suboptimal. Specifically, the commentary emphasizes the intersectionality of smoking history and several important sociodemographic characteristics and identities that should inform lung cancer screening outreach and engagement efforts, including socioeconomic considerations (e.g., health insurance status), racial and ethnic identity, LGBTQ + identity, mental health history, military experience/veteran status, and geographic residence in addressing specific community risk factors and future interventions in efforts to make strides toward equitable lung cancer screening. METHODS Members of the Equitable Implementation of Lung Cancer Screening Interest Group with the Cancer Prevention and Control Network (CPCRN) provide a critical commentary based on existing literature regarding smoking trends in the US and lung cancer screening uptake to propose opportunities to enhance implementation and support equitable distribution of the benefits of lung cancer screening. CONCLUSION The present commentary utilizes information about historical trends in tobacco use to highlight opportunities for targeted outreach efforts to engage communities at high risk with information about the lung cancer screening opportunity. Future efforts toward equitable implementation of lung cancer screening should focus on multi-level implementation strategies that engage and work in concert with community partners to co-create approaches that leverage strengths and reduce barriers within specific communities to achieve the potential of lung cancer screening.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Shacoria Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alison Brenner
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica Currier
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Jaron King
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jackilen Shannon
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Leeann N Siegel
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA.
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18
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Abstract
Current lung cancer screening protocols use low-dose computed tomography scans in selected high-risk individuals. Unfortunately, utilization is low, and the rate of false-positive screens is high. Peripheral biomarkers carry meaningful promise in diagnosing and monitoring cancer with added potential advantages reducing invasive procedures and improving turnaround time. Herein, the use of such blood-based assays is considered as an adjunct to further utilization and accuracy of lung cancer screening.
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Affiliation(s)
- Nathaniel Deboever
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Edwin J Ostrin
- Department of General Internal Medicine, Pulmonary Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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19
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DeBolt CL, Popovich JJ, Widere JC, Wibberly KH, Harris D. Rurality as a Risk Factor for Pulmonary Health Disparities. Clin Chest Med 2023; 44:501-508. [PMID: 37517830 DOI: 10.1016/j.ccm.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Rural populations experience significant pulmonary health disparities compared with urban populations. Patients in rural communities experience health determinants including high smoking prevalence, worse nutrition, lower educational attainment, specific occupational exposures, decreased health-care access, as well as unique cultural and political drivers of health. This article describes social determinants of pulmonary health relevant in rural communities, describes examples of existing pulmonary disparities in rural populations, and highlights health policies with potential to mitigate disparities.
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Affiliation(s)
| | - John J Popovich
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J Christian Widere
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Katharine Hsu Wibberly
- Mid-Atlantic Telehealth Resource Center, University of Virginia, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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20
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Barta JA, Erkmen CP, Shusted CS, Myers RE, Saia C, Cohen S, Wainwright J, Zeigler-Johnson C, Dako F, Wender R, Kane GC, Vachani A, Rendle KA. The Philadelphia Lung Cancer Learning Community: a multi-health-system, citywide approach to lung cancer screening. JNCI Cancer Spectr 2023; 7:pkad071. [PMID: 37713466 PMCID: PMC10588937 DOI: 10.1093/jncics/pkad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lung cancer screening uptake for individuals at high risk is generally low across the United States, and reporting of lung cancer screening practices and outcomes is often limited to single hospitals or institutions. We describe a citywide, multicenter analysis of individuals receiving lung cancer screening integrated with geospatial analyses of neighborhood-level lung cancer risk factors. METHODS The Philadelphia Lung Cancer Learning Community consists of lung cancer screening clinicians and researchers at the 3 largest health systems in the city. This multidisciplinary, multi-institutional team identified a Philadelphia Lung Cancer Learning Community study cohort that included 11 222 Philadelphia residents who underwent low-dose computed tomography for lung cancer screening from 2014 to 2021 at a Philadelphia Lung Cancer Learning Community health-care system. Individual-level demographic and clinical data were obtained, and lung cancer screening participants were geocoded to their Philadelphia census tract of residence. Neighborhood characteristics were integrated with lung cancer screening counts to generate bivariate choropleth maps. RESULTS The combined sample included 37.8% Black adults, 52.4% women, and 56.3% adults who currently smoke. Of 376 residential census tracts in Philadelphia, 358 (95.2%) included 5 or more individuals undergoing lung cancer screening, and the highest counts were geographically clustered around each health system's screening sites. A relatively low percentage of screened adults resided in census tracts with high tobacco retailer density or high smoking prevalence. CONCLUSIONS The sociodemographic characteristics of lung cancer screening participants in Philadelphia varied by health system and neighborhood. These results suggest that a multicenter approach to lung cancer screening can identify vulnerable areas for future tailored approaches to improving lung cancer screening uptake. Future directions should use these findings to develop and test collaborative strategies to increase lung cancer screening at the community and regional levels.
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Affiliation(s)
- Julie A Barta
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Christine S Shusted
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ronald E Myers
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chelsea Saia
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Cohen
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn Wainwright
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charnita Zeigler-Johnson
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, USA
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Farouk Dako
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard Wender
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory C Kane
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anil Vachani
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
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21
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Simkin J, Khoo E, Darvishian M, Sam J, Bhatti P, Lam S, Woods RR. Addressing Inequity in Spatial Access to Lung Cancer Screening. Curr Oncol 2023; 30:8078-8091. [PMID: 37754501 PMCID: PMC10529474 DOI: 10.3390/curroncol30090586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The successful implementation of an equitable lung cancer screening program requires consideration of factors that influence accessibility to screening services. METHODS Using lung cancer cases in British Columbia (BC), Canada, as a proxy for a screen-eligible population, spatial access to 36 screening sites was examined using geospatial mapping and vehicle travel time from residential postal code at diagnosis to the nearest site. The impact of urbanization and Statistics Canada's Canadian Index of Multiple Deprivation were examined. RESULTS Median travel time to the nearest screening site was 11.7 min (interquartile range 6.2-23.2 min). Urbanization was significantly associated with shorter drive time (p < 0.001). Ninety-nine percent of patients with ≥60 min drive times lived in rural areas. Drive times were associated with sex, ethnocultural composition, situational vulnerability, economic dependency, and residential instability. For example, the percentage of cases with drive times ≥60 min among the least deprived situational vulnerability group was 4.7% versus 44.4% in the most deprived group. CONCLUSIONS Populations at risk in rural and remote regions may face more challenges accessing screening services due to increased travel times. Drive times increased with increasing sociodemographic and economic deprivations highlighting groups that may require support to ensure equitable access to lung cancer screening.
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Affiliation(s)
- Jonathan Simkin
- BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 4C2, Canada
| | - Edwin Khoo
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Maryam Darvishian
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Janette Sam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen Lam
- BC Cancer Screening, BC Cancer, Provincial Health Services Authority, Vancouver, BC V5Z 1G1, Canada; (E.K.); (M.D.); (J.S.); (S.L.)
| | - Ryan R. Woods
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1G1, Canada; (P.B.); (R.R.W.)
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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22
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Eberth JM, Gieske MR, Silvestri GA. Changing recommendations for lung cancer screening: National Lung Cancer Roundtable member perspectives. Cancer 2023; 129:1953-1958. [PMID: 37060173 PMCID: PMC10787349 DOI: 10.1002/cncr.34798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Although the revised (2021) US Preventive Services Task Force recommendations for lung cancer screening offer the opportunity to save more lives and reduce disparities, National Lung Cancer Roundtable members share a cautionary message about the challenges ahead. To facilitate high‐quality care for diverse populations, a patient‐centered approach is needed that incorporates high‐quality shared decision‐making, improved access to care and navigation, and more streamlined systems of care.
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Affiliation(s)
- Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Gerard A Silvestri
- School of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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23
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Hughes DR, Chen J, Wallace AE, Rajendra S, Santavicca S, Duszak R, Rula EY, Smith RA. Comparison of Lung Cancer Screening Eligibility and Use between Commercial, Medicare, and Medicare Advantage Enrollees. J Am Coll Radiol 2023; 20:402-410. [PMID: 37001939 DOI: 10.1016/j.jacr.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 03/31/2023]
Abstract
OBJECTIVE Lung cancer screening does not require patient cost-sharing for insured people in the U.S. Little is known about whether other factors associated with patient selection into different insurance plans affect screening rates. We examined screening rates for enrollees in commercial, Medicare Fee-for-Service (FFS), and Medicare Advantage plans. METHODS County-level smoking rates from the 2017 County Health Rankings were used to estimate the number of enrollees eligible for lung cancer screening in two large retrospective claims databases covering: a 5% national sample of Medicare FFS enrollees; and 100% sample of enrollees associated with large commercial and Medicare Advantage carriers. Screening rates were estimated using observed claims, stratified by payer, before aggregation into national estimates by payer and demographics. Chi-square tests were used to examine differences in screening rates between payers. RESULTS There were 1,077,142 enrollees estimated to be eligible for screening. The overall estimated screening rate for enrollees by payer was 1.75% for commercial plans, 3.37% for Medicare FFS, and 4.56% for Medicare Advantage plans. Screening rates were estimated to be lowest among females (1.55%-4.02%), those aged 75-77 years (0.63%-2.87%), those residing in rural areas (1.88%-3.56%), and those in the West (1.16%-3.65%). Among Medicare FFS enrollees, screening rates by race/ethnicity were non-Hispanic White (3.71%), non-Hispanic Black (2.17%) and Other (1.68%). CONCLUSIONS Considerable variation exists in lung cancer screening between different payers and across patient characteristics. Efforts targeting historically vulnerable populations could present opportunities to increase screening.
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Affiliation(s)
- Danny R Hughes
- Director, Health Economics and Analytics Lab, School of Economics, Georgia Institute of Technology, Atlanta, Georgia; Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia; and College of Health Solutions, Arizona State University, Phoenix, Arizona.
| | - Jie Chen
- Department of Health Professions, James Madison University, Harrisonburg, Virginia
| | | | - Shubhrsi Rajendra
- School of Economics, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Richard Duszak
- Chair, Department of Radiology, University of Mississippi Medical Center, Jackson, Mississippi; and Chair, Commission on Leadership and Practice Development, American College of Radiology. https://twitter.com/RichDuszak
| | - Elizabeth Y Rula
- Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Robert A Smith
- Senior Vice President, Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia
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24
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Adams SJ, Stone E, Baldwin DR, Vliegenthart R, Lee P, Fintelmann FJ. Lung cancer screening. Lancet 2023; 401:390-408. [PMID: 36563698 DOI: 10.1016/s0140-6736(22)01694-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Randomised controlled trials, including the National Lung Screening Trial (NLST) and the NELSON trial, have shown reduced mortality with lung cancer screening with low-dose CT compared with chest radiography or no screening. Although research has provided clarity on key issues of lung cancer screening, uncertainty remains about aspects that might be critical to optimise clinical effectiveness and cost-effectiveness. This Review brings together current evidence on lung cancer screening, including an overview of clinical trials, considerations regarding the identification of individuals who benefit from lung cancer screening, management of screen-detected findings, smoking cessation interventions, cost-effectiveness, the role of artificial intelligence and biomarkers, and current challenges, solutions, and opportunities surrounding the implementation of lung cancer screening programmes from an international perspective. Further research into risk models for patient selection, personalised screening intervals, novel biomarkers, integrated cardiovascular disease and chronic obstructive pulmonary disease assessments, smoking cessation interventions, and artificial intelligence for lung nodule detection and risk stratification are key opportunities to increase the efficiency of lung cancer screening and ensure equity of access.
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Affiliation(s)
- Scott J Adams
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Stone
- Faculty of Medicine, University of New South Wales and Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital and National University of Singapore, Singapore
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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25
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Maki KG, Talluri R, Toumazis I, Shete S, Volk RJ. Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility. Cancer Med 2023; 12:4647-4654. [PMID: 35871312 PMCID: PMC9972155 DOI: 10.1002/cam4.5066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation to expand lung cancer screening (LCS) eligibility and mitigate disparities. Although this increased the number of non-White individuals who are eligible for LCS, the update's impact on drivers of disparities is less clear. This analysis focuses on racial disparities among Black individuals because members of this group disproportionately share late-stage lung cancer diagnoses, despite typically having a lower intensity smoking history compared to non-Hispanic White individuals. METHODS We used data from the National Health Interview Survey to examine the impact of the 2021 eligibility criteria on racial disparities by factors such as education, poverty, employment history, and insurance status. We also examined preventive care use and reasons for delaying medical care. RESULTS When comparing Black individuals and non-Hispanic White individuals, our analyses show significant differences in who would be eligible for LCS: Those who do not have a high school diploma (28.7% vs. 17.0%, p = 0.002), are in poverty (26.2% vs. 14.9%, p < 0.001), and have not worked in the past 12 months (66.5% vs. 53.9%, p = 0.009). Further, our analyses also show that more Black individuals delayed medical care due to not having transportation (11.1% vs. 3.6%, p < 0.001) compared to non-Hispanic White individuals. CONCLUSIONS Our results suggest that despite increasing the number of Black individuals who are eligible for LCS, the 2021 USPSTF recommendation highlights ongoing socioeconomic disparities that need to be addressed to ensure equitable access.
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Affiliation(s)
- Kristin G Maki
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Iakovos Toumazis
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert J Volk
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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26
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Abstract
Lung cancer is a leading cause of cancer death in the United States and globally with the majority of lung cancer cases attributable to cigarette smoking. Given the high societal and personal cost of a diagnosis of lung cancer including that most cases of lung cancer when diagnosed are found at a late stage, work over the past 40 years has aimed to detect lung cancer earlier when curative treatment is possible. Screening trials using chest radiography and sputum failed to show a reduction in lung cancer mortality however multiple studies using low dose CT have shown the ability to detect lung cancer early and a survival benefit to those screened. This review will discuss the history of lung cancer screening, current recommendations and screening guidelines, and implementation and components of a lung cancer screening program.
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27
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Are Wellness Visits a Possible and Effective Cure for the Increasing Cancer Burden in Poland? Example of Women's Preventive Services in the U.S. Cancers (Basel) 2022; 14:cancers14174296. [PMID: 36077829 PMCID: PMC9454863 DOI: 10.3390/cancers14174296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Cancer is one of the leading causes of death among Polish women in general, and first in women aged 25−64. Contributing to this cancer burden are modifiable behavioral risk factors, including low utilization of cancer screenings. Poland has an urgent need for new systemic solutions that will decrease cancer burden in the female Polish population. This study examined the United States’ implementation of preventive wellness visits as a viable solution for implementation in Poland. Methods: Health insurance claims data for nearly three million women in five states of the U.S. were examined to identify use of mammograms, colorectal cancer screening, and lung cancer screening. Three subgroups of the cohort were assessed for the probability of receipt of screening associated with type of healthcare visit history (women with wellness visits—W; with wellness visits and related preventive services and screenings—W+P; and control group—C). All multiple comparisons were significant (alpha = 0.05) at p < 0.0001, except comparison between subgroups (W vs. P+W) for lung cancer screening. Results: Breast and colorectal cancer screenings had substantially higher participation after W and W+P in comparison with C; moreover, a slight increase after W or P+W was seen for lung cancer as well. Conclusions: Results indicate that wellness visits are an effective tool for increasing cancer screening among women in the U.S. Introduction of a similar solution in Poland could potentially help produce higher screening rates, address cancer prevention needs (not only for secondary cancer prevention), and lower cancer burden.
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