Willingness to receive lung cancer screening when engaged in community-based locations

Lung cancer is the leading cause of cancer deaths. Low-dose computed tomography (LDCT) screening enables early detection and reduces lung cancer mortality. Yet, less than 10% of eligible individuals participate in LDCT. This study leveraged community connections to measure willingness to undergo lung cancer screening among a diverse population.

Black (n = 437) and White (n = 122) Americans were recruited from community-based locations (eg, barbershops, salons, libraries) in a large city. Participants completed a survey measuring willingness to undergo lung cancer screening if recommended (1 = not at all likely, 10 = very likely). They also answered questions about individual-, provider-, and structural-level screening barriers: medical mistrust (trust in health care system to deliver accurate screening results; 1 = very little trust, 10 = significant level of trust), perceived provider recommendations (how well primary care doctors promote screening in their community; 1 = very poorly, 10 = extremely), and financial accessibility (likelihood of insurance coverage of screening; 1 = very unlikely, 10 = very likely).

Mean age was 38.59 years; 53.6% were female. Screening willingness did not differ by race (Black American: 7.27 ± 3.04 vs White American: 7.21 ± 2.86). Black Americans perceived greater insurance coverage for screening (6.97 ± 3.01 vs 6.43 ± 2.84; P = .07) and lower trust in screening accuracy (6.73 ± 2.56 vs 7.20 ± 2.19; P = .045) than White Americans. No racial differences were found for provider recommendations (Black American: 4.95 ± 2.83 vs White American: 5.08 ± 2.26). Screening willingness was positively associated with financial accessibility (P < .01), trust (P < .01) and provider recommendations (P < .01).

Screening willingness is shaped by financial accessibility, provider recommendations, and trust among both Black and White Americans. Mistrust emerged as a prominent barrier for Black Americans, whereas concerns about insurance coverage were a barrier among White Americans. Efforts to increase screening uptake should use a multilevel approach, with attention to needs across racial groups. The successful recruitment of participants from community-based locations indicates that residents are receptive to information about lung cancer screening outside clinical settings, highlighting opportunities to expand screening education and efforts to these locations to reach diverse populations.