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Potter AL, Senthil P, Srinivasan D, Raman V, Kumar A, Haridas C, Mathey-Andrews C, Zheng W, Jeffrey Yang CF. Persistent race- and sex-based disparities in lung cancer screening eligibility. J Thorac Cardiovasc Surg 2024; 168:248-260.e2. [PMID: 37863179 DOI: 10.1016/j.jtcvs.2023.10.025] [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: 05/11/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To evaluate race- and sex-based disparities in lung cancer screening eligibility under the 2013 US Preventive Services Task Force, 2021 US Preventive Services Task Force, and National Comprehensive Cancer Network lung cancer screening guidelines. METHODS Participants in the Southern Community Cohort Study with a smoking history diagnosed with lung cancer from 2002 to 2021 were identified for analysis. Differences in age at lung cancer diagnosis and smoking characteristics were evaluated among 4 groups: Black men, Black women, White men, and White women. RESULTS A total of 2011 patients with lung cancer met study inclusion criteria, of whom 968 (48.1%) were women and 1248 (62.1%) were Black. Under the 2013 guideline, Black men with lung cancer were significantly less likely to be eligible for screening when compared with White men with lung cancer (37.7% vs 62.4%; P < .001), and Black women with lung cancer were significantly less likely to be eligible for screening when compared with White women with lung cancer (27.8% vs 56.7%; P < .001). Under the 2021 guideline, 62.6% of Black and 73.8% of White men (P < .001) with lung cancer would have been eligible for screening, resulting in an 11.2 percentage point difference in screening eligibility between Black and White men. Under the 2021 guideline, 50.3% of Black and 74.9% of White (P < .001) women with lung cancer would have been eligible for screening; notably, there remained a 24.6 percentage point difference in screening eligibility between Black and White women. In multivariable-adjusted analysis, under the 2021 USPSTF guideline, Black men with lung cancer had 46% lower odds of being eligible for screening compared with White men with lung cancer (multivariable-adjusted odds ratio [aOR], 0.54; 95% CI, 0.39-0.76; P < .001) and Black women with lung cancer had 66% lower odds of being eligible for screening compared with White women with lung cancer (aOR, 0.34; 95% CI, 0.25-0.46; P < .001). The National Comprehensive Cancer Network guideline increased the proportion of patients with lung cancer eligible for screening in each group. CONCLUSIONS In this analysis of patients with lung cancer in the Southern Community Cohort Study, there remained a large gap in lung cancer screening eligibility between Black and White men and women under the 2021 US Preventive Services Task Force guideline. Only 50% of Black women and 63% of Black men diagnosed with lung cancer would have qualified for screening.
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Affiliation(s)
- Alexandra L Potter
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Priyanka Senthil
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Deepti Srinivasan
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Arvind Kumar
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Chinmay Haridas
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Camille Mathey-Andrews
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tenn
| | - Chi-Fu Jeffrey Yang
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
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Japuntich SJ, Walaska K, Friedman EY, Balletto B, Cameron S, Tanzer JR, Fang P, Clark MA, Carey MP, Fava J, Busch AM, Breault C, Rosen R. Lung cancer screening provider recommendation and completion in black and White patients with a smoking history in two healthcare systems: a survey study. BMC PRIMARY CARE 2024; 25:202. [PMID: 38849725 PMCID: PMC11157907 DOI: 10.1186/s12875-024-02452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 05/28/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low dose CT reduces lung cancer mortality. LCS is underutilized. Black people who smoke tobacco have high risk of lung cancer but are less likely to be screened than are White people. This study reports provider recommendation and patient completion of LCS and colorectal cancer screening (CRCS) among patients by race to assess for utilization of LCS. METHODS 3000 patients (oversampled for Black patients) across two healthcare systems (in Rhode Island and Minnesota) who had a chart documented age of 55 to 80 and a smoking history were invited to participate in a survey about cancer screening. Logistic regression analysis compared the rates of recommended and received cancer screenings. RESULTS 1177 participants responded (42% response rate; 45% White, 39% Black). 24% of respondents were eligible for LCS based on USPSTF2013 criteria. One-third of patients eligible for LCS reported that a doctor had recommended screening, compared to 90% of patients reporting a doctor recommended CRCS. Of those recommended screening, 88% reported completing LCS vs. 83% who reported completion of a sigmoidoscopy/colonoscopy. Black patients were equally likely to receive LCS recommendations but less likely to complete LCS when referred compared to White patients. There was no difference in completion of CRCS between Black and White patients. CONCLUSIONS Primary care providers rarely recommend lung cancer screening to patients with a smoking history. Systemic changes are needed to improve provider referral for LCS and to facilitate eligible Black people to complete LCS.
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Affiliation(s)
- Sandra J Japuntich
- Hennepin Healthcare, 730 South 8th St., Minneapolis, MN, 55415, USA.
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA.
- Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA.
| | - Kristen Walaska
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Elena Yuija Friedman
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | - Brittany Balletto
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Sarah Cameron
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | | | - Pearl Fang
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
| | - Melissa A Clark
- Brown University School of Public Health, One Davol Square, 121 South Main St, Providence, RI, 02903, USA
| | - Michael P Carey
- Department of Psychiatry and Human Behavior, Brown University, 75 Waterman St, Providence, RI, 02912, USA
| | - Joseph Fava
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Andrew M Busch
- Hennepin Healthcare, 730 South 8th St., Minneapolis, MN, 55415, USA
- Hennepin Healthcare Research Institute, 701 Park Ave., PP7.700, Minneapolis, MN, 55415, USA
- Department of Medicine, University of Minnesota Medical School, 401 East River Parkway, VCRC 1st Floor, Suite 131, Minneapolis, MN, 55455, USA
| | - Christopher Breault
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
| | - Rochelle Rosen
- The Miriam Hospital, Coro Center West, 1 Hoppin St., Suite 309, Providence, RI, 02903, USA
- Brown University School of Public Health, One Davol Square, 121 South Main St, Providence, RI, 02903, USA
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Núñez ER, Fukunaga MI, Stevens GA, Yang JK, Reid SE, Spiegel JL, Ingemi MR, Wiener RS. Review of Interventions That Improve Uptake of Lung Cancer Screening: A Cataloging of Strategies That Have Been Shown to Work (or Not). Chest 2024:S0012-3692(24)00654-8. [PMID: 38797278 DOI: 10.1016/j.chest.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 05/29/2024] Open
Abstract
TOPIC IMPORTANCE Lung cancer screening (LCS) has the potential to decrease mortality from lung cancer by 20%. Yet, more than a decade since LCS was established as an evidence-based practice, < 20% of the eligible population in the United States has been screened. This review focuses on critically appraising interventions that have been designed to increase the initial uptake of LCS, including how they address known barriers to LCS and their effectiveness in overcoming these barriers. REVIEW FINDINGS Studies were categorized based on the primary barriers that they addressed: (1) identifying eligible patients (including enhancing awareness through smoking history collection, outreach, and education), (2) shared decision-making-related interventions, and (3) patient navigation interventions. Four of the studies included multicomponent interventions, which often included patient navigation as one of the components. Overall, the effectiveness of the studies reviewed at improving LCS uptake generally was modest and was limited by the multilevel barriers that need to be overcome. Multicomponent interventions generally were more effective at improving LCS uptake, but most studies still had relatively low completion of screening. SUMMARY Improving uptake of LCS requires learning from prior interventions to design multilevel interventions that address barriers to LCS at key steps and identifying which components of these interventions are effective and generalizable.
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Affiliation(s)
- Eduardo R Núñez
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA.
| | | | - Gregg A Stevens
- University of Massachusetts Chan Medical School Worcester, MA
| | - James K Yang
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Sarah E Reid
- University of Massachusetts Chan Medical School Worcester, MA
| | - Jennifer L Spiegel
- University of Massachusetts Chan Medical School Worcester, MA; School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Molly R Ingemi
- University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA; National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Lin X, Wang F, Li Y, Lei F, Chen W, Arbing RH, Chen WT, Huang F. Exploring shared decision-making needs in lung cancer screening among high-risk groups and health care providers in China: a qualitative study. BMC Cancer 2024; 24:613. [PMID: 38773461 PMCID: PMC11107036 DOI: 10.1186/s12885-024-12360-0] [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: 01/13/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The intricate balance between the advantages and risks of low-dose computed tomography (LDCT) impedes the utilization of lung cancer screening (LCS). Guiding shared decision-making (SDM) for well-informed choices regarding LCS is pivotal. There has been a notable increase in research related to SDM. However, these studies possess limitations. For example, they may ignore the identification of decision support and needs from the perspective of health care providers and high-risk groups. Additionally, these studies have not adequately addressed the complete SDM process, including pre-decisional needs, the decision-making process, and post-decision experiences. Furthermore, the East-West divide of SDM has been largely ignored. This study aimed to explore the decisional needs and support for shared decision-making for LCS among health care providers and high-risk groups in China. METHODS Informed by the Ottawa Decision-Support Framework, we conducted qualitative, face-to-face in-depth interviews to explore shared decision-making among 30 lung cancer high-risk individuals and 9 health care providers. Content analysis was used for data analysis. RESULTS We identified 4 decisional needs that impair shared decision-making: (1) LCS knowledge deficit; (2) inadequate supportive resources; (3) shared decision-making conceptual bias; and (4) delicate doctor-patient bonds. We identified 3 decision supports: (1) providing information throughout the LCS process; (2) providing shared decision-making decision coaching; and (3) providing decision tools. CONCLUSIONS This study offers valuable insights into the decisional needs and support required to undergo LCS among high-risk individuals and perspectives from health care providers. Future studies should aim to design interventions that enhance the quality of shared decision-making by offering LCS information, decision tools for LCS, and decision coaching for shared decision-making (e.g., through community nurses). Simultaneously, it is crucial to assess individuals' needs for effective deliberation to prevent conflicts and regrets after arriving at a decision.
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Affiliation(s)
- Xiujing Lin
- School of Nursing, Fujian Medical University, No 1, Xueyu Road, Minhou county, Fujian, Fuzhou, 350108, China
| | - Fangfang Wang
- School of Nursing, Fujian Medical University, No 1, Xueyu Road, Minhou county, Fujian, Fuzhou, 350108, China
| | - Yonglin Li
- School of Nursing, Fujian Medical University, No 1, Xueyu Road, Minhou county, Fujian, Fuzhou, 350108, China
| | - Fang Lei
- School of Nursing, University of Minnesota, Twin Cities, Minneapolis, MN, USA
| | - Weisheng Chen
- Department of Thoracic Oncology Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Rachel H Arbing
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA.
| | - Feifei Huang
- School of Nursing, Fujian Medical University, No 1, Xueyu Road, Minhou county, Fujian, Fuzhou, 350108, China.
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Shiels MS, Graubard BI, McNeel TS, Kahle L, Freedman ND. Trends in smoking-attributable and smoking-unrelated lung cancer death rates in the United States, 1991-2018. J Natl Cancer Inst 2024; 116:711-716. [PMID: 38070489 PMCID: PMC11077306 DOI: 10.1093/jnci/djad256] [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: 09/13/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND In the United States, lung cancer death rates have been declining for decades, primarily as a result of pronounced decreases in cigarette smoking. It is unclear, however, whether there have been similar declines in mortality rates of lung cancer unrelated to smoking. We estimated trends in US lung cancer death rates attributable and not attributable to smoking from 1991 to 2018. METHODS The study included 30- to 79-year-olds in the National Health Interview Survey who were linked to the National Death Index, 1991-2014. Adjusted hazard ratios for smoking status and lung cancer death were estimated, and age-specific population attributable fractions were calculated. Annual population attributable fractions were multiplied by annual US national lung cancer mortality, partitioning rates into smoking-attributable and smoking-unrelated lung cancer deaths. All statistical tests were 2-sided. RESULTS During 1991-2018, the proportion of never smokers increased among both men (35.1%-54.6%) and women (54.0%-65.4%). Compared with those who had ever smoked, those who had never smoked had 86% lower risk (hazard ratio = 0.14; 95% confidence interval [CI] = 0.12 to 0.16) of lung cancer death. The fraction of lung cancer deaths attributable to smoking decreased from 81.4% (95% CI = 78.9 to 81.4) to 74.7% (95% CI = 78.1 to 71.4). Smoking-attributable lung cancer death rates declined 2.7% per year (95% CI = ‒2.9% to ‒2.5%) and smoking-unrelated lung cancer death rates declined 1.8% per year (95% CI = ‒2.0% to ‒1.5%); these declines have accelerated in recent years. CONCLUSIONS An increasing proportion of lung cancer deaths are unrelated to smoking based on declines in smoking prevalence. Smoking-unrelated lung cancer death rates have declined, however, perhaps because of decreases in secondhand smoke and air pollution exposure as well as treatment improvements.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | | | - Lisa Kahle
- Information Management Services, Calverton, MD, USA
| | - Neal D Freedman
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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Siddique SM, Tipton K, Leas B, Jepson C, Aysola J, Cohen JB, Flores E, Harhay MO, Schmidt H, Weissman GE, Fricke J, Treadwell JR, Mull NK. The Impact of Health Care Algorithms on Racial and Ethnic Disparities : A Systematic Review. Ann Intern Med 2024; 177:484-496. [PMID: 38467001 DOI: 10.7326/m23-2960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND There is increasing concern for the potential impact of health care algorithms on racial and ethnic disparities. PURPOSE To examine the evidence on how health care algorithms and associated mitigation strategies affect racial and ethnic disparities. DATA SOURCES Several databases were searched for relevant studies published from 1 January 2011 to 30 September 2023. STUDY SELECTION Using predefined criteria and dual review, studies were screened and selected to determine: 1) the effect of algorithms on racial and ethnic disparities in health and health care outcomes and 2) the effect of strategies or approaches to mitigate racial and ethnic bias in the development, validation, dissemination, and implementation of algorithms. DATA EXTRACTION Outcomes of interest (that is, access to health care, quality of care, and health outcomes) were extracted with risk-of-bias assessment using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool and adapted CARE-CPM (Critical Appraisal for Racial and Ethnic Equity in Clinical Prediction Models) equity extension. DATA SYNTHESIS Sixty-three studies (51 modeling, 4 retrospective, 2 prospective, 5 prepost studies, and 1 randomized controlled trial) were included. Heterogenous evidence on algorithms was found to: a) reduce disparities (for example, the revised kidney allocation system), b) perpetuate or exacerbate disparities (for example, severity-of-illness scores applied to critical care resource allocation), and/or c) have no statistically significant effect on select outcomes (for example, the HEART Pathway [history, electrocardiogram, age, risk factors, and troponin]). To mitigate disparities, 7 strategies were identified: removing an input variable, replacing a variable, adding race, adding a non-race-based variable, changing the racial and ethnic composition of the population used in model development, creating separate thresholds for subpopulations, and modifying algorithmic analytic techniques. LIMITATION Results are mostly based on modeling studies and may be highly context-specific. CONCLUSION Algorithms can mitigate, perpetuate, and exacerbate racial and ethnic disparities, regardless of the explicit use of race and ethnicity, but evidence is heterogeneous. Intentionality and implementation of the algorithm can impact the effect on disparities, and there may be tradeoffs in outcomes. PRIMARY FUNDING SOURCE Agency for Healthcare Quality and Research.
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Affiliation(s)
- Shazia Mehmood Siddique
- Division of Gastroenterology, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania; and Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (S.M.S.)
| | - Kelley Tipton
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Brian Leas
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Christopher Jepson
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Jaya Aysola
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Division of General Internal Medicine, University of Pennsylvania; and Penn Medicine Center for Health Equity Advancement, Penn Medicine, Philadelphia, Pennsylvania (J.A.)
| | - Jordana B Cohen
- Division of Renal-Electrolyte and Hypertension, University of Pennsylvania; and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C.)
| | - Emilia Flores
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Michael O Harhay
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Center for Evidence-Based Practice, Penn Medicine; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (M.O.H.)
| | - Harald Schmidt
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania (H.S.)
| | - Gary E Weissman
- Leonard Davis Institute of Health Economics, University of Pennsylvania; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania; and Division of Pulmonary and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania (G.E.W.)
| | - Julie Fricke
- Center for Evidence-Based Practice, Penn Medicine, Philadelphia, Pennsylvania (B.L., E.F., J.F.)
| | - Jonathan R Treadwell
- ECRI-Penn Medicine Evidence-based Practice Center, ECRI, Plymouth Meeting, Pennsylvania (K.T., C.J., J.R.T.)
| | - Nikhil K Mull
- Center for Evidence-Based Practice, Penn Medicine; and Division of Hospital Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (N.K.M.)
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Li CC, Manella J, Kefi SE, Matthews AK. Does the revised LDCT lung cancer screening guideline bridge the racial disparities gap: Results from the health and retirement study. J Natl Med Assoc 2024; 116:180-188. [PMID: 38245469 DOI: 10.1016/j.jnma.2024.01.008] [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: 08/01/2023] [Revised: 10/17/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE This study examined racial/ethnic disparities in lung cancer screening eligibility rates using 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer with low-dose computed tomography (LDCT) and the revised 2021 guidelines. METHODS The study utilized a retrospective and cross-sectional research design by analyzing data from the Health and Retirement Study (HRS). N = 2,823 respondents aged 50-80 who self-reported current smoking were included in the analyses. Binary logistic regression analysis was conducted to examine the changed status of LDCT screening eligibility based on the revised 2021 guidelines by race/ethnicity after adjusting for respondent demographics. RESULTS Our study found substantial increases in screening eligibility rates across racial and ethnic groups when comparing the original and revised guidelines. The largest increase was observed among Black people (174%), Hispanics (152%), those in the other category (118%), and Whites who smoke (80.8%). When comparing original screening guidelines to revised guidelines, Whites who smoke had the highest percentage of changes from "not eligible" to "eligible" (28.3%), followed by individuals in the "other" category (28.1%), Black people (23.2%) and Hispanics who smoke (18.3%) (p < 0.001). Binary logistic regression results further showed that Black people who smoke (OR = 0.71, p = 0.001), as well as Hispanics who smoke (OR=0.54, p < 0.001), were less likely to change from not eligible to eligible for screening compared to Whites who smoke after adopting the revised screening guidelines. Based on the absolute differences in screening eligibility rates between Whites and other racial/ethnic groups, the disparities may have widened under the new guidelines, particularly with larger absolute differences observed between Whites, Black people, and Hispanics. CONCLUSIONS Our study highlights racial/ethnic disparities in LDCT screening eligibility among people who currently smoke. While the revised USPSTF guidelines increased screening eligibility for racial and ethnic minorities, they did not eliminate these disparities and may have widened under the new guidelines. Targeted interventions and policies are necessary to address barriers faced by underrepresented populations and promote equitable access to lung cancer screening.
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Affiliation(s)
- Chien-Ching Li
- Rush University, Department of Health Systems Management, Chicago, Illinois, USA.
| | - Jason Manella
- Endeavor Health, Department of Orthopaedics, Skokie, Illinois, USA
| | - Safa El Kefi
- Columbia University, School of Nursing, Department of Research and Scholarship, New York , NY, USA
| | - Alicia K Matthews
- Columbia University, School of Nursing, Department of Research and Scholarship, New York , NY, USA
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Liao W, Fehnel C, Goss J, Shepherd CJ, Qureshi T, Matthews AT, Ray MA, Faris NR, Pinsky PF, Smeltzer MP, Osarogiagbon RU. Incidentally Detected Lung Cancer in Persons Too Young or Too Old for Lung Cancer Screening in a Mississippi Delta Cohort. J Thorac Oncol 2024; 19:589-600. [PMID: 37984678 DOI: 10.1016/j.jtho.2023.11.015] [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: 08/23/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Lung cancer risk in screening age-ineligible persons with incidentally detected lung nodules is poorly characterized. We evaluated lung cancer risk in two age-ineligible Lung Nodule Program (LNP) cohorts. METHODS Prospective observational study comparing 2-year cumulative lung cancer diagnosis risk, lung cancer characteristics, and overall survival between low-dose computed tomography (LDCT) screening participants aged 50 to 80 years and LNP participants aged 35 to younger than 50 years (young) and older than 80 years (elderly). RESULTS From 2015 to 2022, lung cancer was diagnosed in 329 (3.43%), 39 (1.07%), and 172 (6.87%) LDCT, young, and elderly LNP patients, respectively. The 2-year cumulative incidence was 3.0% (95% confidence intervals [CI]: 2.6%-3.4%) versus 0.79% (CI: 0.54%-1.1%) versus 6.5% (CI: 5.5%-7.6%), respectively, but lung cancer diagnosis risk was similar between young LNP and Lung CT Screening Reporting and Data System (Lung-RADS) 1 (adjusted hazard ratio [aHR] = 0.88 [CI: 0.50-1.56]) and Lung-RADS 2 (aHR = 1.0 [0.58-1.72]). Elderly LNP risk was greater than Lung-RADS 3 (aHR = 2.34 [CI: 1.50-3.65]), but less than 4 (aHR = 0.28 [CI: 0.22-0.35]). Lung cancer was stage I or II in 62.92% of LDCT versus 33.33% of young (p = 0.0003) and 48.26% of elderly (p = 0.0004) LNP cohorts; 16.72%, 41.03%, and 29.65%, respectively, were diagnosed at stage IV. The aggregate 5-year overall survival rates were 57% (CI: 48-67), 55% (CI: 39-79), and 24% (CI: 15-40) (log-rank p < 0.0001). Results were similar after excluding persons with any history of cancer. CONCLUSIONS LNP modestly benefited persons too young or old for screening. Differences in clinical characteristics and outcomes suggest differences in biological characteristics of lung cancer in these three patient cohorts.
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Affiliation(s)
- Wei Liao
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Carrie Fehnel
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Jordan Goss
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | | | - Talat Qureshi
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | | | - Meredith A Ray
- School of Public Health, University of Memphis, Memphis, Tennessee
| | - Nicholas R Faris
- Thoracic Oncology Research Group, Baptist Cancer Center, Memphis, Tennessee
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Alaniz-Cantú EI, Goodwin K, Smith L, Acosta E, Chávez-Iñiguez A, Evans MJ, Gaitán M, Lei F, Yousefi-Nooraie R, Fiscella KA, Rivera MP, Cupertino AP, Cartujano-Barrera F. Understanding the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos: A qualitative study. Front Oncol 2024; 14:1365739. [PMID: 38571494 PMCID: PMC10987732 DOI: 10.3389/fonc.2024.1365739] [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: 01/04/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Rates of lung cancer screening among Latinos remain low. The purpose of the study was to understand the perceived benefits, barriers, and cues to action for lung cancer screening among Latinos. Methods Participants (N=20) were recruited using community-based recruitment strategies. Eligibility criteria included: 1) self-identified as Hispanic/Latino, 2) spoke English and/or Spanish, and 3) met the USA Preventive Services Task Force eligibility criteria for lung cancer screening. Interviews were conducted in Spanish and English, audio recorded, and transcribed verbatim. Using the health belief model, a qualitative theoretical analysis was used to analyze the interviews. Results Participants' mean age was 58.3 years old (SD=5.8), half of the participants were female, 55% had completed high school or lower educational level, and 55% reported speaking more Spanish than English. All participants were currently smoking. Fourteen participants (70%) were unaware of lung cancer screening, and eighteen (90%) did not know they were eligible for lung cancer screening. Regarding lung cancer screening, participants reported multiple perceived benefits (e.g., smoking cessation, early detection of lung cancer, increased survivorship) and barriers (e.g., fear of outcomes, cost, lung cancer screening not being recommended by their clinician). Lastly, multiple cues to actions for lung cancer screening were identified (e.g., family as a cue to action for getting screened). Conclusions Most Latinos who were eligible for lung cancer screening were unaware of it and, when informed, they reported multiple perceived benefits, barriers, and cues to action. These factors provide concrete operational strategies to address lung cancer screening among Latinos.
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Affiliation(s)
- Edgar I. Alaniz-Cantú
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kalese Goodwin
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - London Smith
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Eliany Acosta
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Arlette Chávez-Iñiguez
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Mary Jo Evans
- Imaging Population Health Programs, University of Rochester Medical Center, Rochester, NY, United States
| | - Marcela Gaitán
- National Alliance for Hispanic Health, Washington, DC, United States
| | - Fang Lei
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - Kevin A. Fiscella
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - M. Patricia Rivera
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
- Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States
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10
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Lin X, Lei F, Lin J, Li Y, Chen Q, Arbing R, Chen WT, Huang F. Promoting Lung Cancer Screen Decision-Making and Early Detection Behaviors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00227. [PMID: 38498799 DOI: 10.1097/ncc.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Promoting lung cancer screening (LCS) is complex. Previous studies have overlooked that LCS behaviors are stage based and thus did not identify the characteristics of LCS interventions at different screening stages. OBJECTIVE The aims of this study were to explore the characteristics and efficacy of interventions in promoting LCS decision making and behaviors and to evaluate these interventions. METHODS We conducted a study search from the inception of each bibliographic database to April 8, 2023. The precaution adoption process model was used to synthesize and classify the evidence. The RE-AIM framework was used to evaluate the effectiveness of LCS programs. Heterogeneity tests and meta-analysis were performed using RevMan 5.4 software. RESULTS We included 31 studies that covered 4 LCS topics: knowledge of lung cancer, knowledge of LCS, value clarification exercises, and LCS supportive resources. Patient decision aids outperformed educational materials in improving knowledge and decision outcomes with a significant reduction in decision conflict (standardized mean difference, 0.81; 95% confidence interval, -1.15 to -0.47; P < .001). Completion rates of LCS ranged from 3.6% to 98.8%. Interventions that included screening resources outperformed interventions that used patient decision aids alone in improving LCS completion. The proportions of reported RE-AIM indicators were highest for reach (69.59%), followed by adoption (43.87%), effectiveness (36.13%), implementation (33.33%), and maintenance (9.68%). CONCLUSION Evidence from 31 studies identified intervention characteristics and effectiveness of LCS interventions based on different stages of decision making. IMPLICATIONS FOR PRACTICE It is crucial to develop targeted and systematic interventions based on the characteristics of each stage of LCS to maximize intervention effectiveness and reduce the burden of lung cancer.
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Affiliation(s)
- Xiujing Lin
- Author Affiliations: School of Nursing, Fujian Medical University (Mss X Lin, J Lin, Li, and Q Chen, and Dr Huang), Fuzhou, China; School of Nursing, University of Minnesota (Dr Lei), Twin Cities, Minneapolis; and School of Nursing, University of California Los Angeles (Dr W-T Chen and Ms Arbing)
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11
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Williams RM, Whealan J, Taylor KL, Adams-Campbell L, Miller KE, Foley K, Luta G, Brandt H, Glassmeyer K, Sangraula A, Yee P, Camidge K, Blumenthal J, Modi S, Kratz H. Multilevel approaches to address disparities in lung cancer screening: a study protocol. Implement Sci Commun 2024; 5:15. [PMID: 38365820 PMCID: PMC10870584 DOI: 10.1186/s43058-024-00553-4] [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: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Low-dose computed tomography (lung cancer screening) can reduce lung cancer-specific mortality by 20-24%. Based on this evidence, the United States Preventive Services Task Force recommends annual lung cancer screening for asymptomatic high-risk individuals. Despite this recommendation, utilization is low (3-20%). Lung cancer screening may be particularly beneficial for African American patients because they are more likely to have advanced disease, lower survival, and lower screening rates compared to White individuals. Evidence points to multilevel approaches that simultaneously address multiple determinants to increase screening rates and decrease lung cancer burden in minoritized populations. This study will test the effects of provider- and patient-level strategies for promoting equitable lung cancer screening utilization. METHODS Guided by the Health Disparities Research Framework and the Practical, Robust Implementation and Sustainability Model, we will conduct a quasi-experimental study with four primary care clinics within a large health system (MedStar Health). Individuals eligible for lung cancer screening, defined as 50-80 years old, ≥ 20 pack-years, currently smoking, or quit < 15 years, no history of lung cancer, who have an appointment scheduled with their provider, and who are non-adherent to screening will be identified via the EHR, contacted, and enrolled (N = 184 for implementation clinics, N = 184 for comparison clinics; total N = 368). Provider participants will include those practicing at the partner clinics (N = 26). To increase provider-prompted discussions about lung screening, an electronic health record (EHR) clinician reminder will be sent to providers prior to scheduled visits with the screening-eligible participants. To increase patient-level knowledge and patient activation about screening, an inreach specialist will conduct a pre-visit phone-based educational session with participants. Patient participants will be assessed at baseline and 1-week post-visit to measure provider-patient discussion, screening intentions, and knowledge. Screening referrals and screening completion rates will be assessed via the EHR at 6 months. We will use mixed methods and multilevel assessments of patients and providers to evaluate the implementation outcomes (adoption, feasibility, acceptability, and fidelity). DISCUSSION The study will inform future work designed to measure the independent and overlapping contributions of the multilevel implementation strategies to advance equity in lung screening rates. TRIAL REGISTRATION ClinicalTrials.gov, NCT04675476. Registered December 19, 2020.
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Affiliation(s)
- Randi M Williams
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA.
| | - Julia Whealan
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kathryn L Taylor
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Lucile Adams-Campbell
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | - Kristie Foley
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Heather Brandt
- Epidemiology and Cancer Control Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Katharine Glassmeyer
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Anu Sangraula
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Peyton Yee
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | - Kaylin Camidge
- Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Georgetown University Medical Center, Washington, DC, USA
| | | | | | - Heather Kratz
- The Catholic University of America, Washington, DC, USA
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12
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Hong YR, Wheeler M, Wang R, Karanth S, Yoon HS, Meza R, Kaye F, Bian J, Jeon J, Gould MK, Braithwaite D. Patient-Provider Discussion About Lung Cancer Screening by Race and Ethnicity: Implications for Equitable Uptake of Lung Cancer Screening. Clin Lung Cancer 2024; 25:39-49. [PMID: 37673782 DOI: 10.1016/j.cllc.2023.08.013] [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: 02/16/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Physician-patient discussions regarding lung cancer screening (LCS) are uncommon and its racial and ethnic disparities are under-investigated. We examined the racial and ethnic disparities in the trends and frequency of LCS discussion among the LCS-eligible United States (US) population. METHODS We analyzed data from the Health Information National Trends Survey from 2014 to 2020. LCS-eligible individuals were defined as adults aged 55 to 80 years old who have a current or former smoking history. We estimated the trends and frequency of LCS discussions and adjusted the probability of having an LCS discussion by racial and ethnic groups. RESULTS Among 2136 LCS-eligible participants (representing 22.7 million US adults), 12.9% (95% CI, 10.9%-15%) reported discussing LCS with their providers in the past year. The frequency of LCS discussion was lowest among non-Hispanic White participants (12.3%, 95% CI, 9.9%-14.7%) compared to other racial and ethnic groups (14.1% in Hispanic to 15.3% in non-Hispanic Black). A significant increase over time was only observed among non-Hispanic Black participants (10.1% in 2014 to 22.1% in 2020; P = .05) and non-Hispanic Whites (8.5% in 2014 to 14% in 2020; P = .02). In adjusted analyses, non-Hispanic Black participants (14.6%, 95% CI, 12.3%-16.7%) had a significantly higher probability of LCS discussion than non-Hispanic Whites (12.1%, 95% CI, 11.4%-12.7%). CONCLUSION Patient-provider LCS discussion was uncommon in the LCS-eligible US population. Non-Hispanic Black individuals were more likely to have LCS discussions than other racial and ethnic groups. There is a need for more research to clarify the discordance between LCS discussions and the actual screening uptake in this population.
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Affiliation(s)
- Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL; UF Health Cancer Center, Gainesville, FL.
| | - Meghann Wheeler
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Ruixuan Wang
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL
| | - Shama Karanth
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Hyung-Suk Yoon
- UF Health Cancer Center, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Frederick Kaye
- Division of Hematology & Oncology, College of Medicine, University of Florida, Gainesville, FL
| | - Jiang Bian
- UF Health Cancer Center, Gainesville, FL; Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Dejana Braithwaite
- UF Health Cancer Center, Gainesville, FL; Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL; Department of Surgery, College of Medicine, University of Florida, Gainesville, FL.
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13
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Mandelblatt J, Meza R, Trentham-Dietz A, Heckman-Stoddard B, Feuer E. Using simulation modeling to guide policy to reduce disparities and achieve equity in cancer outcomes: state of the science and a road map for the future. J Natl Cancer Inst Monogr 2023; 2023:159-166. [PMID: 37947330 PMCID: PMC11009490 DOI: 10.1093/jncimonographs/lgad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Jeanne Mandelblatt
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
- Georgetown Lombardi Comprehensive Cancer Center, Cancer Prevention and Control Program, Washington, DC, USA
- Georgetown Lombardi Institute for Cancer and Aging Research, Georgetown University Medical Center, Washington, DC, USA
| | - Rafael Meza
- Department of Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada
| | - Amy Trentham-Dietz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, USA
- Carbone Cancer Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Brandy Heckman-Stoddard
- Breast and Gynecologic Cancer Research Program, Division of Cancer Prevention, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | - Eric Feuer
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
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14
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Chapman C, Jayasekera J, Dash C, Sheppard V, Mandelblatt J. A health equity framework to support the next generation of cancer population simulation models. J Natl Cancer Inst Monogr 2023; 2023:255-264. [PMID: 37947339 PMCID: PMC10846912 DOI: 10.1093/jncimonographs/lgad017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/03/2023] [Accepted: 06/22/2023] [Indexed: 11/12/2023] Open
Abstract
Over the past 2 decades, population simulation modeling has evolved as an effective public health tool for surveillance of cancer trends and estimation of the impact of screening and treatment strategies on incidence and mortality, including documentation of persistent cancer inequities. The goal of this research was to provide a framework to support the next generation of cancer population simulation models to identify leverage points in the cancer control continuum to accelerate achievement of equity in cancer care for minoritized populations. In our framework, systemic racism is conceptualized as the root cause of inequity and an upstream influence acting on subsequent downstream events, which ultimately exert physiological effects on cancer incidence and mortality and competing comorbidities. To date, most simulation models investigating racial inequity have used individual-level race variables. Individual-level race is a proxy for exposure to systemic racism, not a biological construct. However, single-level race variables are suboptimal proxies for the multilevel systems, policies, and practices that perpetuate inequity. We recommend that future models designed to capture relationships between systemic racism and cancer outcomes replace or extend single-level race variables with multilevel measures that capture structural, interpersonal, and internalized racism. Models should investigate actionable levers, such as changes in health care, education, and economic structures and policies to increase equity and reductions in health-care-based interpersonal racism. This integrated approach could support novel research approaches, make explicit the effects of different structures and policies, highlight data gaps in interactions between model components mirroring how factors act in the real world, inform how we collect data to model cancer equity, and generate results that could inform policy.
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Affiliation(s)
- Christina Chapman
- Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston VA, Houston, TX, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, National Institute on Minority Health and Health Disparities, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research and Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Vanessa Sheppard
- Department of Health Behavior and Policy and Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeanne Mandelblatt
- Departments of Oncology and Medicine, Georgetown University Medical Center, Cancer Prevention and Control Program at Georgetown Lombardi Comprehensive Cancer Center and the Georgetown Lombardi Institute for Cancer and Aging Research, Washington, DC, USA
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15
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Webster M, Whealan J, Williams RM, Eyestone E, Le A, Childs J, Kao JY, Martin M, Wolfe S, Yang F, Hung PY, Lau YK, Luta G, Tammemagi M, Meza R, Taylor KL. The tobacco quitline setting as a teachable moment: The Educating Quitline Users About Lung (EQUAL) cancer screening randomized trial. Transl Behav Med 2023; 13:736-747. [PMID: 37616531 DOI: 10.1093/tbm/ibad049] [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: 08/26/2023] Open
Abstract
Although lung cancer screening (LCS) using low-dose CT is recommended for high-risk individuals, screening adherence remains low. We conducted a randomized trial to compare two methods of providing LCS education to Maryland Tobacco Quitline (MTQ) callers in order to assess whether this setting may serve as a teachable moment for LCS-eligible individuals. MTQ callers (50-80 years, 20+ pack-years, prior LCS ≥12 months) completed the baseline and were randomized to the Print- or Web-based version of ShouldIScreen.com. Participants completed 1- and 4-month follow-up assessments to evaluate intervention engagement and LCS-related outcomes. Participants (Print = 152, Web = 146) were 61.7 (SD = 6.3) years old and reported 63.5 pack-years (SD = 36.0). Most identified as Black (54.2%), female (66.1%), having internet access (78.9%), completing other recommended cancer screenings (86.3%), and that they would undergo LCS if recommended by their provider (91.3%). By 4 months, significantly more Print (75.0%) than Web (61.6%) participants had read the materials (P = .01). Most reported the interventions contained "the right amount" of information (92.6%) and prepared them to talk with their doctor (57.2%). Regarding screening-related outcomes, 42.8% (Print) and 43.8% (Web) had scheduled or completed a low-dose CT scan or a shared decision-making visit (P = .86). In a racially diverse sample of LCS-eligible quitline callers, offering LCS educational materials resulted in high intervention engagement and screening-related appointments. As >20% did not have internet access, providing participants' preferred modality (web/print) may improve intervention engagement and knowledge. Improving LCS awareness represents an important opportunity to increase screening among eligible but unscreened quitline callers.
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Affiliation(s)
- Marguerite Webster
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Ariel Le
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jack Childs
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jen-Yuan Kao
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | | | - Sara Wolfe
- Maryland Department of Health, Baltimore, MD, USA
| | - Felice Yang
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Pei-Yao Hung
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Yan Kwan Lau
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - George Luta
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharine's, ON, Canada
| | - Rafael Meza
- Integrative Oncology, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Kee D, Sigel KM, Wisnivesky JP, Kale MS. Timely adherence to follow-up after high-risk lung cancer screenings. J Med Screen 2023; 30:150-155. [PMID: 36916158 DOI: 10.1177/09691413231162507] [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: 03/16/2023]
Abstract
OBJECTIVE To achieve the lung cancer screening (LCS) mortality benefit in clinical trials, timely, real-world follow-up of abnormal test results is necessary. Presently, annual LCS rates are lower than in trials, and adherence to follow-up after suspicious findings has not been well studied. This study examined timely adherence to follow-up recommendations after positive low-dose computed tomography (LDCT) screenings. METHODS This retrospective study included individuals from two academic primary care practices in New York City who met United States Preventative Services Task Force LCS eligibility and had a positive LDCT scan between 2013 and 2020. They were recommended for shorter interval follow-up repeat computed tomography (CT), CT biopsy, or positron emission tomography/CT. Adherence was completion of the prescribed imaging by 15 days after the recommended 7-, 30-, and 90-day follow-up and by 30 days after the 180-day recommended follow-up. RESULTS Among 106 individuals with a positive LDCT scan, 64 (60%) were adherent to follow-up recommendations. Adherence was 72%, 63%, and 42% for recommended follow-ups of 30, 90, and 180 days, respectively. Being male was a predictor of a lower adherence rate. Among 23 individuals newly diagnosed with lung cancer after a positive LDCT scan, 83% were adherent to follow-up testing and 82% of cancers were Stage 1A or limited stage. CONCLUSIONS There was variable adherence to the LCS follow-up recommendations despite positive screening CT, suggesting that even in a well-established screening program there may not be an efficient, systematic approach for follow-up. The delays in repeat testing potentially undermine the benefits of early detection.
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Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Smith L, Williams RM, Whealan J, Windels A, Anderson ED, Parikh V, Breece CJ, Puran N, Shepherd AK, Geronimo M, Luta G, Adams-Campbell L, Taylor KL. Development and Evaluation of Brief Web-Based Education for Primary Care Providers to Address Inequities in Lung Cancer Screening and Smoking Cessation Treatment. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1296-1303. [PMID: 36637713 PMCID: PMC10754418 DOI: 10.1007/s13187-023-02262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Annual lung cancer screening (LCS) is recommended for individuals at high risk for lung cancer. However, primary care provider-initiated discussions about LCS and referrals for screening are low overall, particularly among Black or African Americans and other minoritized racial and ethnic groups. Disparities also exist in receiving provider advice to quit smoking. Effective methods are needed to improve provider knowledge about LCS and tobacco-related disparities, and to provide resources to achieve equity in LCS rates. We report the feasibility and impact of pairing a self-directed Lung Cancer Health Disparities (HD) Web-based course with the National Training Network Lung Cancer Screening (LuCa) course on primary care providers' knowledge about LCS and the health disparities associated with LCS. In a quasi-experimental study, primary care providers (N = 91) recruited from the MedStar Health System were assigned to complete the LuCa course only vs. the LuCa + HD courses. We measured pre-post-LCS-related knowledge and opinions about the courses. The majority (60.4%) of providers were resident physicians. There was no significant difference between groups on post-test knowledge (p > 0.05). However, within groups, there was an improvement in knowledge from pre- to post-test (LuCa only (p = 0.03); LuCa + HD (p < 0.001)). The majority of providers (81%) indicated they planned to improve their screening and preventive practices after having reviewed the educational modules. These findings provide preliminary evidence that this e-learning course can be used to educate providers on LCS, smoking cessation, and related disparities impacting patients.
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Affiliation(s)
- Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA.
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
| | - Allison Windels
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Eric D Anderson
- Department of Interventional Pulmonology, Georgetown University Medical Center, Washington, D.C., USA
| | | | - Chavalia Joan Breece
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Namita Puran
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, D.C., USA
| | - Andrea K Shepherd
- Louise Herrington School of Nursing, Baylor University, Dallas, TX, USA
| | | | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, D.C., 20007, USA
| | - Lucile Adams-Campbell
- Office of Minority Health and Health Disparities Research, Georgetown University Medical Center, Washington, D.C., 20007, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue NW, Suite 300, Washington, D.C., 20007‑2401, USA
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Shiels MS, Lipkowitz S, Campos NG, Schiffman M, Schiller JT, Freedman ND, Berrington de González A. Opportunities for Achieving the Cancer Moonshot Goal of a 50% Reduction in Cancer Mortality by 2047. Cancer Discov 2023; 13:1084-1099. [PMID: 37067240 PMCID: PMC10164123 DOI: 10.1158/2159-8290.cd-23-0208] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
On February 2, 2022, President Biden and First Lady Dr. Biden reignited the Cancer Moonshot, setting a new goal to reduce age-standardized cancer mortality rates by at least 50% over the next 25 years in the United States. We estimated trends in U.S. cancer mortality during 2000 to 2019 for all cancers and the six leading types (lung, colorectum, pancreas, breast, prostate, liver). Cancer death rates overall declined by 1.4% per year from 2000 to 2015, accelerating to 2.3% per year during 2016 to 2019, driven by strong declines in lung cancer mortality (-4.7%/year, 2014 to 2019). Recent declines in colorectal (-2.0%/year, 2010-2019) and breast cancer death rates (-1.2%/year, 2013-2019) also contributed. However, trends for other cancer types were less promising. To achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. We reviewed opportunities to prevent, detect, and treat these common cancers that could further reduce population-level cancer death rates and also reduce disparities. SIGNIFICANCE We reviewed opportunities to prevent, detect, and treat common cancers, and show that to achieve the Moonshot goal, progress against lung, colorectal, and breast cancer deaths needs to be maintained and/or accelerated, and new strategies for prostate, liver, pancreatic, and other cancers are needed. See related commentary by Bertagnolli et al., p. 1049. This article is highlighted in the In This Issue feature, p. 1027.
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Affiliation(s)
- Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Stanley Lipkowitz
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nicole G Campos
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mark Schiffman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - John T Schiller
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Amy Berrington de González
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- The Institute of Cancer Research, London, United Kingdom
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19
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Tam J, Levy DT, Feuer EJ, Jeon J, Holford TR, Meza R. Using the Past to Understand the Future of U.S. and Global Smoking Disparities: A Birth Cohort Perspective. Am J Prev Med 2023; 64:S1-S10. [PMID: 36781373 PMCID: PMC10033336 DOI: 10.1016/j.amepre.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 02/13/2023]
Abstract
U.S. smoking-related disparities persist, but data evaluating how smoking patterns across diverse populations have changed by birth cohort are lacking. Worldwide, smoking continues to exact harm, especially to low- and middle-income nations with less historical data for smoking analyses. The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group previously generated smoking histories for the whole U.S. population using an age, period, and birth cohort (APC) methodological framework. These inputs have been used in numerous models to simulate future patterns of smoking and to evaluate the potential impact of policies. However, the absence of detailed model-ready inputs on smoking behaviors for diverse U.S. populations has been a barrier to research evaluating future trends in smoking-related disparities or the projected impacts of policies across sociodemographic groups. This supplement issue provides new estimates of smoking behaviors with detailed historical data by race/ethnicity, educational attainment, family income, and for each of the 50 U.S. states and Washington, DC. All-cause mortality relative risks associated with smoking by race/ethnicity and educational attainment are also available for the first time. Finally, the supplement issue presents comprehensive smoking histories for Brazil, demonstrating the application of this methodology to resource-limited settings. Collectively, these data aim to offer insight into future U.S. and global smoking disparities and accelerate research on tobacco control policies that advance health equity. This effort will allow tobacco simulation models to account comprehensively for population diversity, thereby enabling researchers to develop more sophisticated analyses of tobacco use and control interventions.
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Affiliation(s)
- Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Eric J Feuer
- Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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20
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Olazagasti C, Seetharamu N, Kohn N, Steiger D. Implementing physician education to increase lung cancer screening uptake. Lung Cancer Manag 2023; 11:LMT55. [PMID: 37122495 PMCID: PMC10135441 DOI: 10.2217/lmt-2022-0008] [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: 07/01/2022] [Accepted: 10/12/2022] [Indexed: 05/02/2023] Open
Abstract
Aim Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The US Preventive Services Task Force and National Comprehensive Cancer Network recommend annual low-dose computed tomography (LDCT) for eligible adults. We conducted a study to assess physician LDCT referral patterns. Methods The study was divided into a pre-, intervention, and post-intervention periods. The intervention was a LC screening educational series. We evaluated rates of LDCT screening referrals during pre- and post-intervention periods. Results In the pre-intervention period, 75 patients fulfilled US Preventive Services Task Force and/or National Comprehensive Cancer Network criteria and 27% underwent LDCT. In the post-intervention period, 135 patients fulfilled either screening criteria of whom 61.5% underwent LDCT. Conclusion In our study, educational lectures improved compliance significantly and should be used as tool for primary care providers to effectively increase LDCT screening referrals.
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Affiliation(s)
- Coral Olazagasti
- Division of Medical Oncology at Sylvester Comprehensive Cancer Center at The University of Miami Miller School of Medicine, FL 33136, USA
- Author for correspondence:
| | - Nagashree Seetharamu
- Division of Hematology-Oncology at Zucker School of Medicine @ Hofstra/Northwell Health New Hyde Park, NY 11042, USA
| | - Nina Kohn
- Department of Biostatistics at Feinstein Institute for Medical Research Great Neck, NY 11021, USA
| | - David Steiger
- Division of Pulmonary & Critical Care at Icahn School of Medicine at Mount Sinai New York, NY 10029, USA
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21
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Wu X, Denise BB, Zhan F, Zhang J. Determining Association between Lung Cancer Mortality Worldwide and Risk Factors Using Fuzzy Inference Modeling and Random Forest Modeling. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192114161. [PMID: 36361041 PMCID: PMC9659002 DOI: 10.3390/ijerph192114161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 06/02/2023]
Abstract
Lung cancer remains the leading cause for cancer mortality worldwide. While it is well-known that smoking is an avoidable high-risk factor for lung cancer, it is necessary to identify the extent to which other modified risk factors might further affect the cell's genetic predisposition for lung cancer susceptibility, and the spreading of carcinogens in various geographical zones. This study aims to examine the association between lung cancer mortality (LCM) and major risk factors. We used Fuzzy Inference Modeling (FIM) and Random Forest Modeling (RFM) approaches to analyze LCM and its possible links to 30 risk factors in 100 countries over the period from 2006 to 2016. Analysis results suggest that in addition to smoking, low physical activity, child wasting, low birth weight due to short gestation, iron deficiency, diet low in nuts and seeds, vitamin A deficiency, low bone mineral density, air pollution, and a diet high in sodium are potential risk factors associated with LCM. This study demonstrates the usefulness of two approaches for multi-factor analysis of determining risk factors associated with cancer mortality.
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Affiliation(s)
- Xiu Wu
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
| | - Blanchard-Boehm Denise
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
| | - F.Benjamin Zhan
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
| | - Jinting Zhang
- School of Resource and Environmental Science, Wuhan University, Wuhan 430070, China
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22
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Chen ZH, Chen ZY, Kang J, Chu XP, Fu R, Zhang JT, Qi YF, Chen JH, Lin JT, Jiang BY, Yang XN, Wu YL, Zhong WZ, Nie Q. Investigation on the incidence and risk factors of lung cancer among Chinese hospital employees. Thorac Cancer 2022; 13:2210-2222. [PMID: 35818719 PMCID: PMC9346177 DOI: 10.1111/1759-7714.14549] [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: 05/01/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022] Open
Abstract
Objective In recent years, the lung cancer incidence has grown and the population is younger. We intend to find out the true detection rate of pulmonary nodules and the incidence of lung cancer in the population and search for the risk factors. Method Hospital employees ≥40 years old who underwent low‐dose computed tomography (CT) lung cancer screening from January 2019 to March 2022 were selected to record CT‐imaging characteristics, pathology, staging, and questionnaires to investigate past history, smoking history, diet, mental health, etc. PM2.5 and radiation intake in radiation‐related occupation received monitoring in hospital. Result The detection rate of suspicious pulmonary nodules was 9.1% (233/2552), and the incidence rate of lung cancer (including adenocarcinoma in situ) was 4.0% (103/2552). Morbidity among doctors, nurses, technicians, administers, and logistics was no difference (p = 0.184), but higher in women than in men (4.7% vs 2.4% p = 0.002). The invasiveness increased with age and CT density of nodules (p = 0.018). The relationship between lung cancer morbidity and PM2.5 was not clear (p = 0.543); and no lung cancer has been found in employees related ionizing radiation. Conclusion The high screening rate has brought about a high incidence of lung cancer. At present, the risk factor analysis of lung cancer based on small samples cannot find the direct cause. Most of the ground glass opacity (GGO)s detected by LDCT screening are indolent, but there are also rapidly progressive lung cancer. A predictive model to identify active and indolent GGO is necessary.
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Affiliation(s)
- Zi-Hao Chen
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhi-Yong Chen
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Kang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiang-Peng Chu
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Rui Fu
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jia-Tao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yi-Fan Qi
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing-Hua Chen
- 12th People's Hospital of Guangzhou, Guangzhou, China
| | - Jun-Tao Lin
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ben-Yuan Jiang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiang Nie
- School of Medicine, South China University of Technology, Guangzhou, China.,Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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23
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Rivera MP, Cupertino P, Henderson LM. Complementary Approaches to Lung Cancer Detection in High-Risk Populations. J Clin Oncol 2022; 40:2074-2077. [PMID: 35605172 DOI: 10.1200/jco.22.00494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester, Rochester, NY
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Paula Cupertino
- Wilmot Cancer Institute, University of Rochester, Rochester, NY
| | - Louise M Henderson
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, NC
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
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