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.

Objective: To explore knowledge and beliefs of long‐term smokers about lung cancer, associated risk factors and lung cancer screening.Design: Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long‐term smokers' who had and had not been screened for lung cancer.Methods: Twenty‐six long‐term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened.Results: While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long‐term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma.Conclusions: Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health‐care system distrust may impact successful implementation of screening programmes. Perceived smoking‐related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision‐making process between health‐care providers and their high‐risk patients.

The U.S. Preventive Services Task Force recommends lung cancer screening with low-dose computed tomography for long-term current and former smokers. However, lung cancer screening and its implementation are a complex issue. Screening has associated risks and potential harms that complicate the decision to screen for the patient, add to the already time-constrained clinical encounter for the provider, and present logistical and sociopolitical challenges in creating and implementing lung cancer screening programs in the health care system. As lung cancer screening is more widely implemented in the United States, it is critical for those in the health care system to be cognizant of potential barriers to effective screening implementation at the patient, provider, and system levels when designing effective support interventions, as well as to proactively address potential impediments to this new screening option. This paper presents perspectives on these multilevel barriers to lung cancer screening.

To examine relationships among demographic variables, healthcare system distrust, lung cancer stigma, smoking status, and timing of medical help-seeking behavior in individuals with symptoms suggestive of lung cancer after controlling for ethnicity, socioeconomic status, and social desirability. Descriptive, cross-sectional, correlational study. Outpatient oncology clinics in Louisville, KY. 94 patients diagnosed in the past three weeks to six years with all stages of lung cancer. Self-report, written survey packets were administered in person followed by a semistructured interview to assess symptoms and timing characteristics of practice-identified patients with lung cancer. Timing of medical help-seeking behavior, healthcare system distrust, lung cancer stigma, and smoking status. Lung cancer stigma was independently associated with timing of medical help-seeking behavior in patients with lung cancer. Healthcare system distrust and smoking status were not independently associated with timing of medical help-seeking behavior. FINDINGS suggest that stigma influences medical help-seeking behavior for lung cancer symptoms, serving as a barrier to prompt medical help-seeking behavior. When designing interventions to promote early medical help-seeking behavior in individuals with symptoms suggestive of lung cancer, methods that consider lung cancer stigma as a barrier that can be addressed through public awareness and patient-targeted interventions should be included.

Lung cancer screening is a relatively new screening option. Inequalities related to screening behavior have been documented in other types of cancer screening. Because stage at presentation drives mortality in lung cancer, it is critical to understand factors that influence screening behavior in lung cancer screening in order to intervene. However, we must first understand where disparities exist in lung cancer screening participation in order to effectively guide intervention efforts. Therefore, the purpose of this study was to determine the association of sociodemographic (including key disparity-related variables) and knowledge with lung cancer screening behavior. This cross-sectional, descriptive study used survey methodology to collect data from 438 screening-eligible individuals in the state of Indiana between January and February 2017 and measured sociodemographic variables and knowledge about lung cancer and screening. Key sociodemographic and health status characteristics associated with screening behavior included race, geographic area of residence, income, health insurance, and family history of lung cancer. Of the variables generally reflective of disparities, key differences were noted by race and geographic area of residence with total knowledge scores as well as screening behavior, respectively. Results indicate key differences in race and geographic area of residence that may perpetuate screening behavior disparities. We have a unique opportunity at this early implementation stage in lung cancer screening to learn what variables influence screening behavior from our target patient population. This knowledge can be used to design equitable patient outreach programs, meaningful, tailored patient engagement materials, and effective patient-clinician decision support tools.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet