Editorial: Increasing Lung Cancer Screening in the Hispanic/Latino(a) Community
Key findings
- The U.S. Preventive Services Task Force now recommends annual lung cancer screening (LCS) with low-dose computed tomography for adults 50–80 years old who have a 20–pack per year smoking history and currently smoke or quit within the past 15 years
- Barriers to LCS uptake that affect all patient populations are magnified among Hispanic/Latino(a) communities (e.g., lack of awareness of eligibility, difficulty reading or understanding educational material, cost concerns and safety concerns due to COVID-19)
- In a recent editorial, Massachusetts General Hospital physicians present a conceptual model for reducing disparities in LCS; it addresses awareness, opportunities and participation at the patient, provider and systems levels
- The principles discussed in the editorial apply to all communities and practices, and the authors encourage radiologists to work toward understanding the unique needs of specific patient populations with regard to LCS
In March, the U.S. Preventive Services Task Force broadened its eligibility criteria for lung cancer screening (LCS). The new guidelines recommend annual low-dose computed tomography for adults 50–80 years old who have a 20–pack per year smoking history and currently smoke or quit within the past 15 years. Formerly, the starting age was 55 and the smoking history criterion was 30 packs per year.
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A recent editorial by Efrén J. Flores, MD, an officer of Radiology Community Health Improvement and Equity in the Department of Radiology at Massachusetts General Hospital, and colleagues urges radiologists to regard this update as a catalyst to improve LCS participation among Hispanic/Latino(a) people. It appears in the Journal of the American College of Radiology.
Rationale
The editorialists cite a number of reasons for focusing on Hispanic/Latino(a) communities:
- According to the latest statistics, only 17% of Hispanic/Latino(a) people with lung cancer are diagnosed while the disease is still localized
- Lower rates of health insurance coverage reduce the likelihood that Hispanic/Latino(a) people will have opportunities to be identified as a person who currently or formerly smoked, receive smoking cessation counseling or be advised to undergo LCS
- Barriers to LCS uptake that affect all patient populations are magnified among this community (e.g., lack of awareness of eligibility criteria, difficulty reading or understanding educational material, cost concerns and safety concerns due to COVID-19)
- Hispanic/Latino(a)communities and other racial/ethnic minority groups tend to have greater exposure than white non-Hispanic patients to lung cancer risk factors besides smoking
A Multilevel Framework
The editorialists present a conceptual model, adapted from one created by the National Institute on Minority Health and Health Disparities, for reducing disparities in LCS. It addresses three promoters of LCS—awareness, opportunities and participation—at three levels of influence—patients, providers and health care systems.
Patients
- Review educational materials
- Provide an accurate smoking history (educational materials should explain why this is important)
- Participate in a shared decision-making conversation about LCS, repeated as necessary
Providers
- Review the new LCS guidelines
- Update patient smoking histories consistently
- Strive to increase LCS enrollment by newly eligible patients
Systems
- Make educational materials about LCS accessible to all patients (multilingual, at an appropriate reading level and image-rich to help with numeracy) and provide materials tailored to the Hispanic/Latino(a)population
- Program electronic medical record systems to identify patients eligible for LCS
- Incorporate LCS in population health and quality metrics dashboards
The authors note that the principles they discuss apply to every community and practice, and they encourage radiologists to work toward understanding the unique needs of specific patient populations with regard to LCS.
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