Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

• DOI: 10.1164/rccm.202008-3053st
• Publication Date: 2020-10-01T14:36:21Z
• Authors: M. Patricia Rivera; Hormuzd A. Katki; Nichole T. Tanner; Matthew Triplette; Lori C. Sakoda; Renda Soylemez Wi...; Roberto Cardarelli; Lisa Carter-Harris; Kristina Crothers; Joelle T. Fathi; Marvella E. Ford; Robert Smith; Robert A. Winn; Juan P. Wisnivesky; Louise M. Henderson; Melinda C. Aldrich
• Keywords: Lung Neoplasms; Eligibility Determination; Health Services Accessibility; Insurance Coverage; 03 medical and health sciences; Sex Factors; 0302 clinical medicine; Ethnicity; Humans; Healthcare Disparities; Referral and Consultation; Early Detection of Cancer; Minority Groups; Implementation Science; American Thoracic Society Documents; Marketing of Health Services; Medically Uninsured; Medicaid; Smoking; Health Care Costs; 3. Good health; Practice Guidelines as Topic; Smoking Cessation; Decision Making, Shared

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.