Broadening Lung Cancer Screening Won’t Shrink Racial Disparities Without Broader Insurance Coverage

NEW YORK (Reuters Health) – The latest U.S. Preventive Services Task Force lung cancer screening recommendations, issued in March, boost the number of eligible individuals by lowering age and cigarette pack requirements, but lack of insurance coverage means many are unlikely to benefit, researchers say.

“Disparities in cancer care are nothing new,” Dr. Gerard Silvestri of the Medical University of South Carolina in Charleston told Reuters Health by email. “Increasing the number of Blacks eligible for screening is a start, but…without access to care, eligibility is meaningless.”

As reported in JAMA Network Open, Dr. Silvestri and colleagues analyzed data from 12,879 non-Hispanic whites and 501 non-Hispanic Blacks who participated in the 2017, 2018, and 2019 Behavioral Risk Factor Surveillance System (BRFSS) surveys.

There were no significant differences according to race and ethnicity with respect to eligibility: about half of each group smoked and about half were 55-64 years old.

The rate of eligible adults reporting being screened was similar between racial groups: non-Hispanic Blacks, 16.5%; non-Hispanic whites, 14.0%.

But while screening rates were similar, close to 80% of non-Hispanic Blacks who reported being screened were of Medicare age, compared to roughly 51% of non-Hispanic whites, suggesting that access to care plays a significant role in whether someone is screened.

The authors state, “The new USPSTF recommendations will include screening eligibility for an additional 7 million younger Americans and a higher proportion of Black adults within this group will be uninsured. The findings here suggest that given the association insurance may have on the ability to be screened, disparities could paradoxically worsen rather than improve.”

To reduce disparities, Dr. Silvestri said, “We can increase insurance coverage through multiple mechanisms such as Medicaid expansion, lowering the age for eligibility for Medicare, both or a national health insurance coverage for all. Organizations that should take the lead are state and federal governments, advocacy groups, physician specialty societies and patients themselves, who should demand these benefits.”

Dr. Arturo Loaiza-Bonilla, Medical Director of Clinical Research, Cancer Treatment Centers of America, Atlanta said the results mirror his clinical experience.

“Overall, we notice that underrepresented minorities are most affected when disparities exist,” he said. “Many of these patients in our practice present at later stages of their cancers due to delaying screening, and this ‘shadow curve’ has been exacerbated in the age of COVID-19. We need to do better.”

“Local governments, nonprofit organizations and advocacy groups should team up in a ‘cancer prevention and screening task force’ with regional influence, to address these disparities issues and avoid duplicative efforts,” he said. “Using technology, social media campaigns, and bringing the screening tools directly to the most marginalized communities may have a major impact.”

As Dr. Silvestri noted, Dr. Loaiza-Bonilla said, “Asking Medicaid to cover these screening tools is also key, as they improve outcomes and reduce cost in the long run, translating to a sustainable initiative.”

“We need to take the lead in each of our practices,” he concluded. “Engage patients, caregivers, families and communities around cancer prevention and screening at each opportunity.”

SOURCE: JAMA Network Open, online October 20, 2021.

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