Lung Cancer Screening in California and Los Angeles County: A Landscape Analysis

Area of Science:

• Public Health
• Health Services Research
• Oncology

Background:

• Lung cancer screening with low-dose computed tomography (LDCT) reduces mortality but faces low uptake and significant racial/socioeconomic disparities in California.
• California's screening rates are among the nation's lowest, with substantial inequities impacting high-risk populations.

Purpose of the Study:

• To characterize the lung cancer screening implementation ecosystem in California and Los Angeles (LA) County.
• To identify barriers and inform stakeholders on improving screening equity.

Main Methods:

• Structured review of peer-reviewed and grey literature using PRISMA-ScR guidelines.
• Synthesis of information on policy, healthcare systems, infrastructure, risk factors, and outcomes.
• Analysis within the context of established cancer screening programs and California's safety-net systems.

Main Results:

• Lung cancer screening lacks infrastructure and regulatory frameworks seen in established programs (e.g., MQSA).
• California's healthcare system presents challenges: low MediCal reimbursement, complex contracts, and strained FQHCs.
• LA County shows geographic maldistribution of LDCT facilities, with underserved communities having least access.
• High-risk populations, including people of color, face concentrated tobacco retailers and air quality risks.

Conclusions:

• California's lung cancer screening ecosystem is defined by policy, system, and risk distribution barriers.
• Low screening rates, late-stage diagnoses, and racial disparities highlight the urgent need for evidence-informed interventions to improve equity.