Lung cancer is the second most common cancer, excluding skin cancer, diagnosed in men and women in the United States. And despite advances in treatment for the disease, which have led to improved survival rates, lung cancer remains the leading cause of cancer mortality in the United States, with individuals of color and those living in rural areas of the country experiencing the worst outcomes.
In 2021, the U.S. Preventive Services Task Force recommended annual lung cancer screening for adults aged 50 to 80 who have a 20-year history of smoking one pack of cigarettes a day and currently smoke or have quit within the past 15 years.
The results from a cross-sectional ecologic study have found that differences exist in travel distance to lung cancer screening facilities by race and ethnicity, and they can only partially be explained by rurality. These findings could inform the placement of future imaging locations and mobile lung cancer screening units to increase equitable access to screening services. The study, by Amiri et al, was published in Annals of Internal Medicine.
Study Methodology
The researchers studied data from 71,691 U.S. census tracts, which included between 2,500 and 8,000 people, to examine race-, ethnicity-, and rurality-based differences in travel distance to the nearest lung cancer screening facility. The census tracts were classified as majority (> 50%) American Indian/Alaska Native (AI/AN), Asian, Black, non-Hispanic White, no single race, or Hispanic. Rurality was defined using the rural-urban commuting area codes. Ordinary least-squares regression examined the associations between distance and census tract race, ethnicity, and rurality.
Key Results
KEY POINTS
- Compared with the non-Hispanic White majority, census tracts distance to the nearest lung cancer screening facility was 5.26 times (426%) longer in in American Indian/Alaska Native–majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts.
- When adjusted for rurality, the mean distance in in American Indian/Alaska Native–majority tracts was reduced but was still more than three times the distance in non-Hispanic White–majority census tracts.</li>
<li>Adjusting for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of association in the Hispanic-majority census tracts.</li></ul>" />
The researchers found that the geometric mean distance to the nearest lung cancer screening facility was 6.5 miles. Compared with the non-Hispanic White majority, census tracts distance to the nearest lung cancer screening facility was 5.26 times (426%) longer in American Indian/Alaska Native–majority census tracts and 7% to 39% shorter in Asian-, Black-, and Hispanic-majority census tracts. Adjustment for rurality reduced the mean distance in American Indian/Alaska Native–majority census tracts, but the mean distance was still 3.16 times the distance in non-Hispanic White–majority census tracts. Adjustment for rurality reduced the observed advantage in Asian- and Black-majority census tracts and changed the direction of associations in Hispanic-majority census tracts.
“Future research documenting the extent to which equitable access to lung cancer screening facilities affects lung cancer screening uptake and lung cancer outcomes would be an important contribution to achieving cancer health-care equity,” concluded the study authors.
Solmaz Amiri, DDes, MSc, of Elson S. Floyd College of Medicine, Washington State University, is the corresponding author of this study.
Disclosure: Funding for this study was provided by the Lung Ambition Alliance and the Center for Lung Research in Honor of Wayne Gittinger. For full disclosures of the study authors, visit www.acponline.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
