Opportunities and Challenges to Lung Cancer Screening in Rural Texas
Introduction
Lung cancer is a leading cause of cancer-related deaths in the United States, often diagnosed at late stages which contributes to high mortality rates. Low-dose computed tomography (LDCT) screening has demonstrated significant effectiveness in reducing lung cancer mortality, particularly among individuals at risk due to their smoking history. However, despite its benefits, the uptake rate of LDCT screening remains alarmingly low, especially among vulnerable populations residing in rural and medically underserved areas. It is also important to note that primary care and family medicine clinicians play a crucial collaborative role in promoting lung cancer education and screening in at-risk populations. Essential collaborative activities include distributing educational materials to participants and providing referrals for smoking cessation consultations. Therefore, it is critical to establish a cohesive provider referral network for tobacco cessation programs and lung cancer screening.
Methods
The goal of this project is to provide lung cancer prevention education, support smoking cessation activities, perform LDCT scans, and provide patient navigation across the continuum of care to qualifying older (55-77), low-income residents of 13 Texas counties, including 9 rural counties and 10 classified as whole-county medically underserved areas (MUAs). The project incorporates components from an established lung cancer screening/early detection program at subcontractor St. Joseph Regional Health Center, leverages existing well-established clinical and community partnerships, and incorporates community health workers/promotor(a)s for patient education and intake, barriers reduction, and navigation to services.
Results
Despite best efforts to promote lung cancer screening, actual uptake of LDCT screening has been minimal. To date, six referrals have been received. Of those, four participants completed smoking cessation counseling and subsequent LDCT. In our sample, we noted that even with established physician networks and comprehensive outreach efforts, rural and medically underserved populations face numerous barriers to screening, including transportation and limited access to screening facilities, lack of knowledge and preventive attitudes, insufficient physician recommendations, concerns regarding the accuracy of screening tests, stigma towards smokers, and fear of radiation exposure. These barriers impede their ability to undergo timely screening.
Conclusion
By leveraging the expertise and support of a multidisciplinary team including clinicians, researchers, and community health workers, lung cancer screening programs can be enhanced, disparities can be reduced, and the burden of the disease on vulnerable populations can be mitigated. However, community and clinician engagement is vital. Partnerships and collaboration are needed to expand the reach and impact of this program to promote lung cancer screening and improve outcomes for at-risk individuals. To promote early detection and prevention behavior, it is crucial to address personal and structural barriers that impact knowledge, attitudes, and beliefs concerning lung cancer screening uptake with patients and clinicians. This is especially true in rural and medically underserved areas in Texas.