Grant Details
Grant Number: |
1R03CA297359-01 Interpret this number |
Primary Investigator: |
Wain, Kris |
Organization: |
Kaiser Foundation Research Institute |
Project Title: |
Examining Barriers to Lung Cancer Screening |
Fiscal Year: |
2025 |
Abstract
PROJECT SUMMARY
Lung cancer is the leading cause of cancer related deaths with an estimated 125,000 deaths occurring in 2024.
Trials have shown that lung cancer screening (LCS) via low dose computed tomography decreased risk of lung
cancer death by 20%, however minority populations were underrepresented in trials even though they may be
at increased risk for lung cancer. Despite the known benefits, less than 30% of eligible individuals receive LCS,
far below rates of other recommended cancer screenings, with disparities most evident among minority
populations. In contrast to other recommended cancer screenings, individuals eligible for LCS may face unique
barriers given the extensive smoking history requirements. Individuals with an extensive smoking history may
have additional chronic conditions, different health seeking behaviors, and increased risk of cancer compared
to non-smokers, specifically choosing to forgo LCS due to fears their long-term smoking will result in a cancer
diagnosis. However, it is unknown whether individuals who smoke also choose to forgo other recommended
cancer screenings. Moreover, fewer facilities are capable of providing LCS as compared to other types of
preventive cancer screening. Individuals with lengthier travel times to LCS facilities face higher direct costs
(e.g. transportation costs) and indirect costs (lost productivity due to extended travel time), which may further
deter LCS participation, particularly among minority and low SES populations with already strained resources.
Available studies often rely upon cross sectional questionnaires that examine homogenous samples which
may not generalize to diverse populations, while observational studies often lack smoking history data and
cannot identify a comparison group of LCS eligible individuals that did not receive screening. The objective of
this study is to address noted research gaps quantifying barriers to LCS and provide healthcare systems with
real-world evidence to design interventions aimed at improving the screening process by leveraging the novel
data infrastructure established through the National Cancer Institute-sponsored Population-based Research to
Optimize the Screening Process Lung Research Center. We propose the following 2 aims: 1) Evaluate whether
individuals who are up to date for other cancer screenings are more likely to participate in LCS, stratifying our
analyses by race and ethnicity. We will compare differences in LCS outcomes among 3 different groups:
individuals up to date for all eligible cancer screenings (colorectal, breast, and cervical), individuals who
previously received cancer screening but are not currently up-to-date, and individuals with no history of cancer
screening. 2) Estimate the impact drive time to the nearest LCS facility has on screening participation,
stratifying our analyses by race and ethnicity. Using a difference-in-differences approach, we will quantify the
impact that a decrease in drive time has on screening participation after a clinic initiates LCS services near an
individual's home residence. Results from this study can inform outreach efforts aimed at enhancing LCS
participation and adherence, while reducing screening disparities.
Publications
None