The Patient Perspective on Lung Cancer Screening and Health Disparities

Lung cancer screening is just starting to be implemented across the United States. Challenges to screening include access to care, awareness of the option for screening, stigma and implicit bias that are due to stigmatization of smoking, stigma of race, nihilism with lung cancer diagnosis viewed as a "death sentence," shared decision making, and underestimation of lung cancer risk. African Americans (AA) have the highest lung cancer mortality rate in the United States despite similar smoking rates as whites. AAs are diagnosed at a later stage, and there is a greater likelihood they will refuse treatment options when diagnosed. Additionally, fewer AAs were found to meet lung cancer screening eligibility criteria compared with whites because of lower tobacco exposure and younger age at time of diagnosis. Outreach and access for lung cancer screening in the AA community and other subpopulations at risk are critical to avoid further increasing disparities in lung cancer morbidity and mortality as lung cancer screening is implemented across the United States. The path forward requires implementing outreach programs and providing lung cancer screening in underserved communities at high risk for lung cancer; consideration of using National Comprehensive Cancer Network guidelines for screening selection criteria, including risk model screening selection; and developing interventions to address stigma, clinician implicit bias, and nihilism.