Geography Hampers Access to Lung Cancer Screening

Victoria Stern, MA

February 22, 2022

About 5% of people who are eligible to receive lung cancer screening do not live close to a facility and have limited or no access to screening, a recent analysis shows.

That percentage, although quite small, still translates to more than 750,000 individuals who are eligible to receive lung cancer screening but live at least 40 miles from a facility.

Overall, a larger proportion of eligible individuals in rural areas had no access to a facility, but a greater number of people in urban areas had no access, especially at shorter distances.

Understanding access issues is important given that "lung cancer screening with low-dose computed tomography scanning (LDCT) reduces mortality among high-risk adults" but "annual screening rates remain low," write study authors Liora Sahar, PhD, of the American Cancer Society in Atlanta, and colleagues.

The study was published online February 15 in the journal Cancer.

It expands on a previous report, which found that "less than 6% of those 55 to 79 years of age do not have access to registry screening facilities."

The new analysis incorporates the most recent guidelines from the US Preventive Services Task Force, which lowered the screening age to 50 years, and compares access across urban and rural areas.

Sahar and colleagues calculated the distances from population centers to screening facilities and estimated the number of individuals living within different distances of those facilities — 10, 20, 40, 50, and 100 miles. Geographical subdivisions, or census tracts, were also classified along a spectrum of rural to urban.

The authors found that, overall, about 14.8 million people aged 50-80 years are eligible for lung cancer screening, and that 5.1% of that population — or 753,038 individuals — do not live within 40 miles of a facility and have no access to screening.

The proportion of people affected by access issues varies by geographic location. For eligible people living 40 miles or more from a facility, almost 25% (n = 287,803) in rural counties had no access compared with 1.6% (n = 195,120) in metropolitan areas.

At greater distances to facilities (50 and 100 miles), these proportions diminish. In rural counties, for instance, 16% of eligible individuals (n = 186,401) living 50 or more miles away and 2.8% (n = 33,504) living 100 or more miles away had no access to a facility.

Not surprisingly, across all distances, "there is a significantly higher percentage of rural residents who do not have access to facilities in comparison with those in urban settings," the authors write. "There are fewer facilities in rural areas, so residents need to travel longer distances to reach a facility."

Notably, however, distance to a facility was not necessarily the greatest barrier to screening. The authors found a greater number of eligible individuals living in or close to urban areas were not getting screening when facilities were 10 miles away — more than 2.8 million in metropolitan areas vs just over 1 million in rural areas.

"The total number of individuals with no access in urban areas exceeds that of rural individuals, particularly at shorter distances," which "reveals an additional underserved population."

Identifying geographic areas with greater access issues can help researchers address barriers to screening and improve uptake. 

"Areas and local pockets with persistently low or no access across short and long distances should be considered for tailored interventions such as implementing mobile units, repurposing existing imaging or health facilities, and adding appropriate navigation, radiology, and screening program staff to better support the communities," the authors conclude.

The study was supported in part by the National Lung Cancer Roundtable. Co-author Debra S. Dyer, MD, serves on the clinical advisory board for computer software company Imidex and on the GO2 Foundation scientific advisory board; she also serves as a consultant for Lung Ambition Alliance. Co-author Ella A. Kazerooni, MD, reports past participation on the Bristol Myers Squibb Foundation advisory board. The other authors have disclosed no relevant financial relationships.

Cancer. Published February 15, 2022. Full text

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