Racial and socioeconomic disparities in lung cancer screening in the United States: A systematic review

Abstract

Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer deaths. Lung cancer screening (LCS) reduces NSCLC mortality; however, a lack of diversity in LCS studies may limit the generalizability of the results to marginalized groups who face higher risk for and worse outcomes from NSCLC. Identifying sources of inequity in the LCS pipeline is essential to reduce disparities in NSCLC outcomes. The authors searched 3 major databases for studies published from January 1, 2010 to February 27, 2020 that met the following criteria: 1) included screenees between ages 45 and 80 years who were current or former smokers, 2) written in English, 3) conducted in the United States, and 4) discussed socioeconomic and race-based LCS outcomes. Eligible studies were assessed for risk of bias. Of 3721 studies screened, 21 were eligible. Eligible studies were evaluated, and their findings were categorized into 3 themes related to LCS disparities faced by Black and socioeconomically disadvantaged individuals: 1) eligibility; 2) utilization, perception, and utility; and 3) postscreening behavior and care. Disparities in LCS exist along racial and socioeconomic lines. There are several steps along the LCS pipeline in which Black and socioeconomically disadvantaged individuals miss the potential benefits of LCS, resulting in increased mortality. This study identified potential sources of inequity that require further investigation. The authors recommend the implementation of prospective trials that evaluate eligibility criteria for underserved groups and the creation of interventions focused on improving utilization and follow-up care to decrease LCS disparities.

Keywords: disparities; lung cancer; lung cancer screening; racial minorities; socioeconomic status.

Figure 1.. Screening process for articles included in the systematic review.

This diagram shows each step in the selection process for articles included in the systematic review.

Figure 2.. Lung cancer screening pipeline.

This schematic presents all reported findings captured by this systematic review. Statements in italics indicate contentious or ambiguous results. Any associations not shown were not reported or captured by our search and thus require further study.

Figure 3.. Risk of Bias Assessment.

This figure shows the risk of bias determination for each article included in the systematic review. *Due to the nature of the studies included in the review, the repeated exposure measurement assessment criterion is not applicable and was thus not considered in the quality rating decision.