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Lung Cancer Screening Access and Cancer Stage at Diagnosis Among American Indian and White Patients
Bradford E Jackson1, Madison Uhrin2, Stephanie B Wheeler1,3
1Lineberger Comprehensive Cancer Center (LCCC), University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, North Carolina, USA.
Purpose:
Given persistently low rates of lung cancer screening among eligible individuals, we examined racial and geographic differences in proximity to low-dose computed tomography (LDCT) screening facilities among American Indians and Alaska Natives (AIAN) and White adults in North Carolina.
Methods:
We used cancer registry data linked with health insurance claims (2016-2020) to examine a cohort of 18,154 AIAN and NHW lung cancer patients. We calculated straight-line distances between patient's residential ZIP code and nearest LDCT facility available in the year prior to diagnosis, (within ZIP code, 1-10 miles, or ≥10 miles). Logistic regression models assessed associations between distance and stage at diagnosis (localized vs. non-localized and distant vs. non-distant), adjusting for race, age at diagnosis, and health insurance status.
Findings:
AIAN were more likely than NHW patients to live ≥10 miles from an LDCT facility (36% vs. 17%) and less often diagnosed at a localized stage (19% vs. 26%). Patients living ≥ 10 miles away had lower odds of localized stage diagnosis (adjusted OR = 0.89; 95% CI: 0.82-0.98) compared to those with access within their residential ZIP code.
Conclusions:
Greater distance to LDCT facilities was associated with reduced odds of early-stage diagnosis. Strategies such as mobile screening units and culturally tailored outreach may improve access and outcomes in underserved AIAN communities.
