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. 2023 Nov 9:11:1264342.
doi: 10.3389/fpubh.2023.1264342. eCollection 2023.

Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption

Charlotte Poon  1 , Tim Wilsdon  1 , Iqra Sarwar  1 , Alexander Roediger  2 , Megan Yuan  3
Affiliations

Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption

Charlotte Poon et al. Front Public Health. .

Abstract

Strong evidence of lung cancer screening's effectiveness in mortality reduction, as demonstrated in the National Lung Screening Trial (NLST) in the US and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON), has prompted countries to implement formal lung cancer screening programs. However, adoption rates remain largely low. This study aims to understand how lung cancer screening programs are currently performing. It also identifies the barriers and enablers contributing to adoption of lung cancer screening across 10 case study countries: Canada, China, Croatia, Japan, Poland, South Korea and the United States. Adoption rates vary significantly across studied countries. We find five main factors impacting adoption: (1) political prioritization of lung cancer (2) financial incentives/cost sharing and hidden ancillary costs (3) infrastructure to support provision of screening services (4) awareness around lung cancer screening and risk factors and (5) cultural views and stigma around lung cancer. Although these factors have application across the countries, the weighting of each factor on driving or hindering adoption varies by country. The five areas set out by this research should be factored into policy making and implementation to maximize effectiveness and outreach of lung cancer screening programs.

Keywords: adoption; country analysis; early detection; lung cancer; screening.

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Conflict of interest statement

CP and TW are employees of Charles River Associates (IS was an employee of Charles River Associates during the research), which was commissioned by Merck & Co., Inc., Kenilworth, NJ, United States, to provide research/writing support for this manuscript. Charles River Associates is an economic consultancy company with a long-established reputation for independent analysis. The views expressed herein are the views and opinions of the authors and do not reflect or represent the views of Charles River Associates or any of the organizations with which the authors are affiliated. AR is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, United States, who may own stock and/or hold stock options in the Company. MY was an employee of Merck & Co., Inc., during the research.

Figures

Figure 1
Figure 1
Set of research questions. Source: CRA analysis.
Figure 2
Figure 2
Summary of the key events and timeline in the development of lung cancer screening in the US. Source: CRA analysis.
Figure 3
Figure 3
Lung cancer screening across provinces in Canada. Source: CRA analysis.
Figure 4
Figure 4
Adoption rates across countries and key drivers. Source: CRA analysis.
See this image and copyright information in PMC

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