Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence

Julie A Barta; Christine S Shusted; Brooke Ruane; Marcella Pimpinelli; Russell K McIntire; Charnita Zeigler-Johnson; Ronald E Myers; Nathaniel R Evans; Gregory C Kane; Hee-Soon Juon

doi:10.1016/j.cllc.2021.06.003

Racial Differences in Lung Cancer Screening Beliefs and Screening Adherence

Clin Lung Cancer. 2021 Nov;22(6):570-578. doi: 10.1016/j.cllc.2021.06.003. Epub 2021 Jun 13.

Affiliations

¹ The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Philadelphia, PA.
² The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Department of Medicine, Philadelphia, PA.
³ Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
⁴ Thomas Jefferson University, Jefferson College of Population Health, Philadelphia, PA.
⁵ Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA.
⁶ The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Thoracic Surgery, Philadelphia, PA.
⁷ Thomas Jefferson University, Department of Medical Oncology, Division of Population Science, Philadelphia, PA. Electronic address: Hee-soon.Juon@jefferson.edu.

PMID: 34257020
DOI: 10.1016/j.cllc.2021.06.003

Abstract

Background: One challenge in high-quality lung cancer screening (LCS) is maintaining adherence with annual and short-interval follow-up screens among high-risk individuals who have undergone baseline low-dose CT (LDCT). This study aimed to characterize attitudes and beliefs toward lung cancer and LCS and to identify factors associated with LCS adherence.

Methods: We administered a questionnaire to 269 LCS participants to assess attitudes and beliefs toward lung cancer and LCS. Clinical data including sociodemographics and screening adherence were obtained from the LCS Program Registry.

Results: African-American individuals had significantly greater lung cancer worries compared with Whites (6.10 vs. 4.66, P < .001). In making the decision to undergo LCS, African-American participants described screening convenience and cost as very important factors significantly more frequently than Whites (60% vs. 26.8%, P< .001 and 58.4% vs. 37.8%, P = .001; respectively). African-American individuals with greater than high school education had significantly higher odds of LCS adherence (aOR 2.55; 95% CI, 1.14-5.60) than Whites with less than high school education. Participants who described screening convenience and cost as "very important" had significantly lower odds of completing screening follow-up after adjusting for demographic and other factors (aOR 0.56; 95% CI, 0.33-0.97 and aOR 0.54; 95% CI, 0.33-0.91, respectively).

Conclusion: Racial differences in beliefs about lung cancer and LCS exist among African-American and White individuals enrolled in an LCS program. Cost, convenience, and low educational attainment may be barriers to LCS adherence, specifically among African-American individuals.

Impact: More research is needed on how barriers can be overcome to improve LCS adherence.

Keywords: Behavioral prevention research; Cancer interception: cancer screening; Cancer prevention: cancer risk assessment; Cancer prevention: early detection; lung cancer screening (LCS) adherence, barriers to LCS, race, education, lung cancer beliefs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Early Detection of Cancer*
Female
Healthcare Disparities*
Humans
Lung Neoplasms / diagnosis*
Male
Mass Screening*
Middle Aged
Patient Acceptance of Health Care
Race Factors*
Surveys and Questionnaires