Achieving Equitable Care for Racial Minority Patients With a Lung Cancer Screening Program.

Abstract

Racial minority patients with lung cancer have more advanced stage, lower resection rates, and worse overall survival, especially among Black men. Lung cancer screening with low-dose computed tomography (LDCT) can reduce mortality; however, the influence of race on access is unknown. This study evaluated LDCT's impact on timely diagnosis and treatment. Patients undergoing LDCT at an urban academic center were enrolled in a cohort study from November 2012 to February 2019. Baseline demographic, cancer-specific, and treatment-specific factors were analyzed and compared with city and state averages. Subgroup analysis was performed by sex. The study cohort included 2552 patients (male, 51.3%; median age, 63 years; White, 70.4%; Black, 28.6%; average smoking pack-years, 43). Higher screening rates for Black men (12.9% vs 6.11%; P < .0001) and Black women (15.7% vs 6.68%; P < .0001) were found compared with the greater metropolitan area population. Lung cancer was identified in 3.7% of the screened population. Lung cancer incidence was similar between Black and White patients (3.3% vs 3.9%; P = .46), with no difference in stage at diagnosis. There were increased rates of early-stage diagnosis compared with state averages (52.5% vs 27.0%; P < .0001). Black patients had no differences in delays to care (>8 weeks) and equitable rates of surgical resection compared with White patients (63.6% vs 62.9%; P = .95). A structured LDCT program can provide access to lung cancer screening to a high number of racial minority patients and provide equitable care through timely diagnosis and treatment. This study underscores the importance of optimizing screening to deliver equitable outcomes for all lung cancer patients.