Social Determinants of Lung Cancer Screening: Knowledge Gaps and Controversies
1Sakib M. Adnan MD, 1Kristine Chin, 2Grace X. Ma, PhD, 1Cherie P. Erkmen, MD
1Temple University Hospital, Philadelphia, PA
2Center for Asian Health, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Lung cancer is the most prevalent malignancy and most common cause of cancer-related death worldwide. While the utility of routine lung cancer screening (LCS) with low-dose computed tomography (LDCT) had previously been under debate, its mortality benefit is now established after reports from multiple prospective trials. In response, there has been an expansion of LCS programs for asymptomatic, high-risk individuals, with downstream increases in diagnosis of early-stage disease and long-term survival. Specifically, the Center for Medicare & Medicaid Services instituted LCS coverage in February 2015 and expanded screening eligibility in February 2022. However, these reassuring metrics are accompanied by limitations in screening practices, especially when applying LCS recommendations toward marginalized groups. Historically, cancer screening guidelines are drawn from clinical trials that largely underrepresent minorities and women. This has fostered further discussion on screening strategies and protocols, exposing a need for strategic screening practices for marginalized groups and minority populations. The aim of the current clinical practice review is to present these knowledge gaps and controversies, with a focus towards disparities and social determinants associated with lung cancer management.
