Underserved Populations 'Left Out of Lung Cancer Screening'

Liam Davenport

December 21, 2016

AUSTRIA — The majority of patients referred to lung cancer screening programs live close to the screening site, and remote and underserved populations are left out and potentially denied life-saving treatment, suggests an analysis of referral patterns.

The findings come from an analysis of referral patterns across 13 counties in Washington State. They were presented here at the 17th World Conference on Lung Cancer (WCLC). The results show that less than 20% of referrals to a lung cancer screening program are from medically underserved areas, with the majority of patients living less than 10 miles away.

Lead author Candice Wilshire, MD, Interventional Pulmonolgy and Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington, and colleagues write: "Creative and coordinated approaches, like telemedicine, will be required to address the potential lack of lung cancer screening services in underserved/shortage areas and facilitate individuals remaining in their communities."

Lung cancer screening with low-dose CT was introduced in the United States after the National Lung Screening Trial revealed that the intervention yielded a 20% reduction in lung cancer mortality. The screening is aimed at individuals at high risk for lung cancer, such as smokers and former heavy smokers.

Although the 33 medical centers included in that trial were primarily academic, urban-based sites, US census data indicate that smoking is most commonly found in adults of low income and educational status who do not have private medical insurance.

Survey Details

To determined whether medically underserved and geographically remote individuals are underrepresented in their hospital-based screening program, the researchers reviewed all individuals referred for screening at the Swedish Medical Center and Cancer Institute in Seattle between 2012 and 2016.

They then determined whether the participants were living in a medically underserved area, using the following definitions:

  • Medically underserved area (MUA): a region deficient in healthcare resources

  • Medically underserved population (MUP): an area with economic/cultural/linguistic barriers to primary care services

  • Health professional shortage area (HPSA): an area with a shortage of primary care physicians

The team found that of 599 individuals referred to the screening program, 511 (85%) were from the metropolitan area of King County. In contrast, just 10 individuals (2%) who were referred to the program lived in geographically remote Clallam County. The remaining 78 referrals (13%) were from 11 counties clustered around King County.

Overall, 19% of referred individuals resided in an MUA, 2% lived in an MUP, and 5% resided in an HPSA. Of the MUAs, 54% referred individuals to the screening program; 24% of MUPs and 15% of HPSAs referred individuals.

The median distance of residence from the screening site was 9 miles. For individuals living in King County, the median distance was 8 miles, and for people living in Clallam County, it was 80 miles. The median distance traveled to the screening program for people living in the other 11 counties was 24 miles.

Summarizing the findings, the team said: "The majority of individuals referred [for lung cancer screening] reside within 10 miles of the lung cancer screening site. Less than 20% reside in designated underserved/shortage areas, and <55% of underserved/shortage areas are represented."

No funding for the study has been declared. The researchers have disclosed no relevant financial relationships.

17th World Conference on Lung Cancer (WCLC). Poster P1.03-051, presented December 5, 2016.

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