Key points are not available for this paper at this time.
Despite evidence that lung cancer screening (LCS) improves survival for at-risk populations and is supported by national guidelines, the 2022 State of Lung Cancer report indicated that only 5. 8% of eligible Americans have been screened for lung cancer. 1Aberle D. R. Adams A. M. et al. National Lung Screening Trial Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (8230) Google Scholar, 2American Lung AssociationState of Lung Cancer 2023 Report. American Lung Association website. https: //www. lung. org/getmedia/186786b6-18c3-46a9-a7e7-810f3ce4deda/SOLC-2023-Print-Report. pdfDate accessed: June 10, 2024Google Scholar When considering segments of the US population most vulnerable to missed health screening opportunities, historically marginalized racial and ethnic groups are perceived to be at highest risk. These groups face challenging socioeconomic obstacles such as proximity of screening, financial burdens, language barriers, and lack of knowledge regarding screening benefits that all may contribute to poor adherence. 3Sin M. -K. Taylor V. Tu S. -P. Issues in lung cancer screening among Asian American immigrants. J Immigr Minor Health. 2016; 18: 495-496Crossref PubMed Scopus (5) Google Scholar As one of the fastest growing racial groups in the United States, Asian Americans represent nearly 6% of the US population and have lower documented screening rates for common cancers including breast and colorectal. 4Sabatino S. A. Thompson T. D. White M. C. et al. Cancer screening test receipt—United States, 2018. MMWR Morb Mortal Wkly Rep. 2021; 70: 29-35Crossref PubMed Google Scholar With limited screening data available in this patient population, concern exists regarding poor LCS adherence that may diminish the potential to save lives and to affect this valuable community positively. Barta et al5Barta et al. Asian-Americans in a lung cancer screening program have lower annual adherence compared with other race groups. Chest Pulm. Forthcoming. Google Scholar reported findings collected from the Thomas Jefferson LCS program on individuals enrolled between January 2018 and December 2022 in Philadelphia, the sixth largest US city with an intercity Asian American population, estimated to number around 133, 000. 6United States Census BureauPhiladelphia city, Philadelphia County, Pennsylvania. United States Census Bureau website. https: //data. census. gov/profile/Philadelphiacity, PhiladelphiaCounty, Pennsylvania? g=060XX00US4210160000#race-and-ethnicityDate accessed: June 12, 2024Google Scholar The full screening cohort consisted of 2, 257 individuals, with 122 people (5. 4%) self-reporting as Asian American. The Asian American cohort, nearly all born outside of the United States, consisted of individuals who self-reported as Chinese (30. 3%), Korean (28. 7%), and Vietnamese (18. 9%). Uniquely, when compared with White enrollees, the Asian American group consisted of a statistically significant higher percentage of male participants (86. 1%), with a higher proportion of current tobacco users (58. 2%), with higher rates of Medicaid insurance coverage (38. 5%), and with a higher proportion of individuals with less than a high school education (31. 1%). After completion of LCS, Asian Americans had American College of Radiology Lung CT Screening Reporting and Data System (Lung-RADS) categories similar to those of other racial groups, with 93. 4% having Lung-RADS class 1 or 2 results and a similar distribution of incidental findings. 7Christensen J. Prosper A. E. Wu C. C. et al. ACR Lung-RADS v2022: assessment categories and management recommendations. J Am Coll Radiol. 2024; 21: 473-488Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Of interest, the Asian American cohort contained a higher percentage of patients with Lung-RADS class 3 disease when compared with other racial groups, but only contained one patient with Lung-RADS class 4 disease and detected no lung cancers. Unfortunately, annual adherence to LCS in the Asian American cohort, the primary study outcome for Barta et al, 5Barta et al. Asian-Americans in a lung cancer screening program have lower annual adherence compared with other race groups. Chest Pulm. Forthcoming. Google Scholar was significantly less than that of comparison racial groups, with only 21. 4% of eligible Asian Americans returning within 18 months for yearly follow-up, as opposed to 41. 3% of Black people and 42. 2% of White people (P <. 001). This pattern of diminished follow-up continued for patients with more worrisome Lung-RADS class 3 disease, with Asian Americans having the lowest rate of CT imaging follow-up within 8 months as compared with Black and White people (45. 5% vs 57. 1% and 63. 6%, respectively). In multivariate regression modeling, Asian American race and lower education levels (less than a high school diploma) were associated independently with lower odds of adherence to annual LCS after adjustment for age, sex, smoking status, and COPD. Although limited by sample size, one could propose that the diminished rate of LCS adherence among Asian Americans may have adversely affected the ability to identify screening-detected lung cancers. Most lung cancers are attributed directly to smoking, and highly developed screening programs view tobacco cessation as a crucial mission to reduce lung cancer rates for active tobacco users. 8US Department of Health and Human ServicesThe Health Consequences of Smoking—50 Years of Progress: a Report of the Surgeon General. US Department for Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014Google Scholar Prior studies have shown that smoking cessation rates during screening vary from 7% to 23%, and individuals who quit smoking report that screening played a key role in their decision to stop smoking. 9Moldovanu D. de Koning H. J. van der Aalst C. M. Lung cancer screening and smoking cessation efforts. Transl Lung Cancer Res. 2021; 10: 1099-1109Crossref PubMed Scopus (39) Google Scholar Barta et al5Barta et al. Asian-Americans in a lung cancer screening program have lower annual adherence compared with other race groups. Chest Pulm. Forthcoming. Google Scholar demonstrated that Asian Americans have an interest in tobacco counseling and a willingness to accept a pharmacotherapy plan at rates similar to Black people and more frequently than White people do. These observations suggest that smoking cessation rates should be at least equal to those of other racial groups, but Asian Americans self-reported that 30-day smoking abstinence rates were less than half that of other racial groups. Individuals with low socioeconomic status and education level are more likely to smoke, and more than one-quarter of tobacco users live at less than the national poverty line. 10Denney J. T. Sharp G. Kimbro R. T. Community social environments and cigarette smoking. SSM Popul Health. 2022; 19101167Google Scholar Many reasons are likely for the reduced smoking cessation rates among Asian Americans undergoing LCS in this study, but enhanced educational efforts that are culturally tailored are needed to promote greater success with smoking cessation. National US screening data report that only a small fraction of eligible US citizens undergo annual lung screening. 11Henderson L. M. Su I. H. Rivera M. P. et al. Prevalence of lung cancer screening in the US, 2022. JAMA Netw Open. 2024; 7e243190Crossref Scopus (2) Google Scholar With limited data available on LCS adherence in Asian Americans, this study presents insightful data about lung cancer risk factors and LCS outcomes among Asian Americans living in the Northeast. Programmatic screening challenges faced in the Northeast may vary from those faced in the Asian-Pacific or the Western United States, but this study clearly demonstrated that Asian Americans are at enhanced risk of diminished adhere to LCS. Future work is needed to expand LCS data collection among Asian Americans in more diverse geographic areas, with enhanced effort to include Asian American female participants to understand better how smoking affects their lung cancer risk. The 2022 State of Lung Cancer report demonstrated that "people of color who are diagnosed with lung cancer face worse outcomes compared to white Americans, " with lower overall survival rates and higher likelihood of advanced stage of disease at the time of diagnosis. To change the paradigm, we need to identify lung cancer at earlier stages, and LCS provides one potential solution. Successful LCS requires not only an initial commitment, but also persistence and dedication to subsequent CT scans based on Lung-RADS scoring. Barta et al5Barta et al. Asian-Americans in a lung cancer screening program have lower annual adherence compared with other race groups. Chest Pulm. Forthcoming. Google Scholar present compelling data that Asian Americans are at enhanced risk of diminished adherence to LCS and bring attention to the fact that efforts are needed by the medical community to investigate LCS barriers and to formulate initiatives to improve screening equity. This crucial work is needed if we are to fulfill the mission of the Cancer Moonshot to "reduce the death rate from cancer by at least 50 percent over the next 25 years, and improve the experience of people and their families living with and surviving cancer. "12The White HouseFact sheet: President Biden reignites cancer moonshot to end cancer as we know it. The White House website. https: //www. whitehouse. gov/briefing-room/statements-releases/2022/02/02/fact-sheet-president-biden-reignites-cancer-moonshot-to-end-cancer-as-we-know-itDate accessed: June 19, 2024Google Scholar None declared. Asian Americans in a Lung Cancer Screening Program Have Lower Annual Adherence Compared With Other Race GroupsCHEST Pulmonary
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