Awareness Of Lung Cancer Screening Research Articles

Access to Lung Cancer Screening Among American Indian and Alaska Native Adults: A Qualitative Study

Lung cancer is the leading cause of cancer mortality among American Indian and Alaska Native populations. American Indian and Alaska Native people use commercial tobacco products at higher rates compared with all other races and ethnicities. Moreover, they show lower adherence to cancer screening guidelines. How do American Indian and Alaska Native adults perceive and use lung cancer screening? We conducted a study in which we recorded and transcribed data from three focus groups consisting of American Indian and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding. Participants (n= 58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at health care facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multigenerational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about cancer risk. Limited access to and awareness of lung cancer screening must be addressed. American Indian and Alaska Native adults use several health information sources unique to tribal communities, and these should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and use of lung cancer screening.

Tobacco treatment specialists’ knowledge, attitudes and beliefs about lung cancer screening: Potential piece of the puzzle for increasing lung cancer screening awareness

ObjectivesLess than 5% of eligible U.S. individuals undergo lung cancer screening (LCS). A significant barrier is lack of awareness; more effective outreach and education strategies are needed to achieve greater population LCS uptake. Tobacco Treatment Specialists (TTSs) are an untapped resource to assist and understanding TTS knowledge and perspectives about LCS and readiness and capacity to assist is a critical first step. MethodsA sequential explanatory mixed-methods study design was conducted to understand LCS knowledge, attitudes, beliefs, and practices of TTSs. A cross-sectional survey (N = 147) was conducted supplemented with 3 focus groups (N = 12). ResultsTTSs lacked good working knowledge about LCS in general and screening guidelines, but think it is important for their patient population and open to routinely assessing and adding this educational component into their current workflow. ConclusionsTobacco treatment offers a unique venue for LCS awareness and is a setting where there are experienced specialists trained in tobacco use assessment and treatment. Results highlight the unmet training needs required to facilitate integration of tobacco treatment and LCS. Practice ImplicationsTTSs are an expanding healthcare workforce. There is a strong need for current TTSs to receive additional training in the benefits of LCS.

Enhancing lung cancer screening through ‘Saved by the Scan’: Lessons from a multipronged public service advertising program.

10575 Background: Lung cancer screening rates remain low across the US in populations recommended for screening by low-dose CT (LDCT). Screening rates further declined during the COVID-19 pandemic, particularly in high-risk populations including racial and ethnic minorities. The American Lung Association (ALA) launched a nationwide public service advertising (PSA) program called ‘Saved by the Scan’ to enhance lung cancer screening rates, for which Baptist Health South Florida (BHSF) became the first healthcare system partner. The following work describes this major PSA effort in South Florida to enhance lung cancer screening, and the lessons learned thereof. Methods: A multipronged, institutionally-driven public awareness program, in collaboration with ALA, was initiated in 2021 by BHSF, the largest healthcare organization in the region, and was targeted towards South Florida residents. This innovative multimedia effort used traditional communication modalities, including newspapers, billboards, etc., along with digital modalities, including email and social media, to increase lung cancer screening awareness in both English and Spanish in a locally-adapted manner. Key performance indicators (KPIs), reach, and impact of the program were tracked. The most successful components, as per KPIs, were identified. Deidentified data of screening LDCT done at BHSF was reviewed to determine all individuals screened during 2019-2021 and descriptive statistics were calculated. Results: 4619 individuals from South Florida were screened at BHSF from 2019-2021, 1498 were in 2019, 1193 in 2020, and 1928 in 2021. Screening fell by 20.3% in 2020, likely due to the pandemic, and rose by 61.6% in 2021, helped by the program. Overall, a 21.9% increase from pre-COVID screening rates was seen. In 2022, the total reach of traditional media was estimated to be 4,607,273 individuals. Out of 133,554 emails sent, 36,877 (27.2%) were opened, with a click-through rate of 6.4%. Out of 1,768,438 digital impressions, 16,791 (0.9%) had links clicked. The total number of conversions from digital media was estimated to be 337 individuals with 232 (68.9%) from emails and 105 (31.1%) from social media. Conclusions: Lung cancer screening can be successfully boosted through large organizational efforts, particularly those targeted to needs of the local population. Digital media approaches for improving public health have seemingly low conversion rates but their large outreach provides a high impact. Efforts are warranted to enroll more healthcare systems and scale the program nationwide.

Leveraging social media to increase lung cancer screening awareness, knowledge and uptake among high-risk populations (The INSPIRE-Lung Study): study protocol of design and methods of a community-based randomized controlled trial

BackgroundLung cancer is the leading cause of cancer death for both men and women in the United States. The National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer mortality among high-risk individuals, but uptake of lung screening remains low. Social media platforms have the potential to reach a large number of people, including those who are at high risk for lung cancer but who may not be aware of or have access to lung screening.MethodsThis paper discusses the protocol for a randomized controlled trial (RCT) that leverages FBTA to reach screening-eligible individuals in the community at large and intervene with a public-facing, tailored health communication intervention (LungTalk) to increase awareness of, and knowledge about, lung screening.DiscussionThis study will provide important information to inform the ability to refine implementation processes for national population efforts to scale a public-facing health communication focused intervention using social media to increase screening uptake of appropriate, high-risk individuals.Trial registrationThe trial is registered at clinicaltrials.gov (#NCT05824273).

Using Community Health Advisors to Increase Lung Cancer Screening Awareness in the Black Belt: a Pilot Study.

Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause, there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured LCS knowledge before and after receiving education delivered by community health advisors (CHAs) among high-risk individuals living in medically underserved communities of Alabama and to determine impact of psychological, demographic, health status, and cognitive factors on rate of lung cancer screening participation. Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment, and disproportionate lack of access to health services). One hundred individuals (i) aged between 55 and 80years; (ii) currently smoke or have quit within the past 15years; and (iii) have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre- and post-knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Average age was 62.94 (SD = 6.28), mostly female (54%); mostly current smokers (53%). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64 (SD = 2.37) to 7.61 (SD = 2.26). Of the 100 participants, 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. Sixty-five percent of those who were screened reported no family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.

Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population.

IntroductionA suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF).MethodsThis was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019–February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit.ResultsA total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40–49 years old and 6.7% (6/90) of those 30–39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years.ConclusionMany ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.

Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals.

This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals' knowledge and awareness of lung cancer screening served as secondary outcomes. Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system. Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals' knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery. The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.

Lung Cancer-Specific Mortality Risk and Public Health Insurance: A Prospective Cohort Study in Chongqing, Southwest China.

ObjectiveThe incidence and mortality of lung cancer rank first among malignant tumors, and its long treatment cycle will bring serious economic burdens to lung cancer patients and their families. There are few studies on the prognosis of lung cancer and insurance policies. This article explores the relationship between the lung cancer-specific death and public health insurance, self-paying rate, and the joint effect of public health insurance and self-paying rate.Materials and MethodsA prospective longitudinal cohort study was conducted in Chongqing, China from 2013 to 2019. The selected subjects were patients with C33–C34 coded according to the tenth edition of the International Classification of Diseases (ICD-10), aged 20 years or older. We conduct a subgroup analysis based on public health insurance types and self-paying rates. After following the inclusion and exclusion criteria, the chi-square test was used to describe the demographic and clinical characteristics of patients with different insurance types and different self-paying rates. Multivariate logistic regression was used to analyze the relationship between patients with different insurance types, self-paying rates, and lung cancer treatment methods. Finally, the Cox proportional hazard model and the competitive risk model are used to calculate the cumulative hazard ratio of all-cause death and lung cancer-specific death for different insurance types and different self-paying rate groups.ResultsA total of 12,464 patients with lung cancer were included in this study. During the follow-up period (median 13 months, interquartile range 5.6–25.2 months), 5,803 deaths were observed, of which 3,781 died of lung cancer. Compared with patients who received urban resident-based basic medical insurance (URBMI), patients who received urban employee-based basic medical insurance (UEBMI) had a 38.1% higher risk of lung cancer-specific death (Hazard Ratios (HRs) = 1.381, 95% confidence interval (CI): 1.293–1.476, P < 0.005), Compared with patients with insufficient self-paying rate, patients with a higher self-paying rate had a 40.2% lower risk of lung cancer-specific death (HRs = 0.598, 95% CI: 0.557–0.643, P < 0.005). Every 10% increase in self-paying rate of URBMI reduces the risk of lung cancer-specific death by 17.6%, while every 10% increase in self-paying rate of UEBMI reduces the risk of lung cancer-specific death by 18.0%.ConclusionsThe National Medical Security Administration should, under the condition of limited medical insurance funds, try to include the original self-paid anti-tumor drugs into the national medical insurance coverage. This can not only reduce the mortality rate of lung cancer patients, but also reduce the family burden of lung cancer patients. On the other hand, high-risk groups should increase their awareness of lung cancer screening and actively participate in the national cancer screening project led by the state.

Using social media and direct marketing as a platform to increase awareness of lung cancer screening in a Hispanic urban population in the post-COVID period.

339 Background: Uptake in lung cancer screening (LCS) in high-risk patients including minority populations has been low despite efforts to increase awareness in the community. During the COVID pandemic, most LCS programs were temporarily stopped and, in the months to follow experienced a significant reduction in referrals. Platforms including social media and direct mail marketing can provide a valuable tool to enhance patient engagement related to LCS and engagement of Hispanic populations who are active consumers of digital media. The objective of this study was to assess the short-term effectiveness of a targeted LCS digital and direct marketing campaign to increase visits to the institutional online educational content and referrals to a LCS program. Methods: A LCS marketing campaign including social media utilizing Facebook and Instagram platforms with programmatic banners, boosted organic social media posts, plus direct mail-in marketing in Spanish and English was started in the post-COVID period. A CRM (customer-relationship management) software was used to target adults ages 50-80, current or former smokers, who speak English and/or Spanish in the Miami tri-county area over a three-month period by a direct-mail campaign. Other campaign targeting qualifications included family history of lung cancer, and additional lung cancer risk factors including asbestos, chronic obstructive pulmonary disease, or emphysema. The CRM Direct mail campaign was sent 87,000 leads by postcard and 65,810 leads by email. Primary outcomes measures were visits to the University of Miami institutional LCS Web page, LDCT ambulatory referrals, and scheduled initial LDCT exams. Study period was baseline pre-COVID period (6/1/2019-12/31/2019), COVID-period (3/1/2020-9/31/2020) and digital awareness campaign in the post-COVID period (12/1/2020-5/31/2020). Results: Unique pageviews to the institutional LCS web pages were significantly higher during the digital awareness campaign compared to the pre-COVID period (8,805 vs 230 pageviews) with a high bounce rate during the campaign period of 79% and average time in site of 2:21 minutes. Mean scheduled initial LDCT volumes per month during the pre-COVID period were 12.4 (SD 4.6), versus 4.1 (SD 2.5) during the COVID period. There was a 3-fold increase in initial LDCT scans during the initial campaign period from 4.1 in the COVID period to 11.6 (p &lt;.001). The mean number of LDCT ambulatory referrals doubled from 17.5 in the COVID period to 34.2 in the campaign period (p &lt; 0.001). Conclusions: Implementation of a targeted LCS digital awareness campaign and direct mail marketing was associated with increased visits to institutional education Web pages, ambulatory referrals, and initial LDCT exams. Digital platforms are an important tool to enhance awareness of lung cancer screening in high-risk populations and Hispanics.

Using community health advisors to increase lung cancer screening awareness in the Black Belt: A pilot study.

117 Background: Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured (LCS) knowledge before and after receiving education delivered by Community Health Advisors (CHAs) among high-risk individuals living in medically-underserved communities of Alabama and to determine impact of psychological, demographic, health status and cognitive factors on rate of lung cancer screening participation. Methods: Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment and disproportionate lack of access to health services).100 individuals (i) aged between 55 to 80 years (ii) Currently smoke or have quit within the past 15 years. (iii) Have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre and post knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Results: Average age was 62.94(SD = 6.28), mostly female (54%); mostly current smokers (53% ). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64(SD = 2.37) to 7.61(SD = 2.26). Of the 100 participants, only 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. 65% of those who were screened reported family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Conclusions: Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.

Risk Perception Among a Lung Cancer Screening Population

A successful lung cancer screening program requires a patient cohort at sufficient risk of developing cancer who are willing to participate. Among other factors, a patient's lung cancer risk perception may inform their attitudes toward screening and smoking cessation programs. This study analyzed data from the Pan-Canadian Early Detection of Lung Cancer (PanCan) Study to address the following questions: Which factors are associated with the perception of lung cancer risk? Is there an association between risk perception for lung cancer and actual calculated risk? Is there an association between risk perception for lung cancer and the intent to quit smoking? Are there potential targets for lung cancer screening awareness? The PanCan study recruited current or former smokers aged 50 to 75 years who had at least a 2%risk of developing lung cancer over 6 years to undergo low-dose screening CT. Risk perception and worry about lung cancer were captured on a baseline questionnaire. Cumulative logistic regression analysis was used to assess the relationship between baseline risk variables and both lung cancer risk perception and worry. Among the 2,514 individuals analyzed, a higher perceived risk of lung cancer was positively associated with calculated risk (P= .032). Younger age, being a former smoker, respiratory symptoms, lower FEV1, COPD, and a family history of lung cancer were associated with higher perceived risk. Conversely, a consistent relationship between calculated risk and worry was not identified. There was a positive association between risk perception and lung cancer worry and reported intent to quit smoking. Individuals' lung cancer risk perception correlated positively with calculated risk in a screening population. Promotion of screening programs may benefit from focusing on factors associated with higher risk perception; conversely, harnessing worry seemingly holds less value.

Computer-Tailored Decision Support Tool for Lung Cancer Screening: Community-Based Pilot Randomized Controlled Trial

BackgroundLung cancer screening is a US Preventive Services Task Force Grade B recommendation that has been shown to decrease lung cancer-related mortality by approximately 20%. However, making the decision to screen, or not, for lung cancer is a complex decision because there are potential risks (eg, false positive results, overdiagnosis). Shared decision making was incorporated into the lung cancer screening guideline and, for the first time, is a requirement for reimbursement of a cancer screening test from Medicare. Awareness of lung cancer screening remains low in both the general and screening-eligible populations. When a screening-eligible person visits their clinician never having heard about lung cancer screening, engaging in shared decision making to arrive at an informed decision can be a challenge. Methods to effectively prepare patients for these clinical encounters and support both patients and clinicians to engage in these important discussions are needed.ObjectiveThe aim of the study was to estimate the effects of a computer-tailored decision support tool that meets the certification criteria of the International Patient Decision Aid Standards that will prepare individuals and support shared decision making in lung cancer screening decisions.MethodsA pilot randomized controlled trial with a community-based sample of 60 screening-eligible participants who have never been screened for lung cancer was conducted. Approximately half of the participants (n=31) were randomized to view LungTalk—a web-based tailored computer program—while the other half (n=29) viewed generic information about lung cancer screening from the American Cancer Society. The outcomes that were compared included lung cancer and screening knowledge, lung cancer screening health beliefs (perceived risk, perceived benefits, perceived barriers, and self-efficacy), and perception of being prepared to engage in a discussion about lung cancer screening with their clinician.ResultsKnowledge scores increased significantly for both groups with greater improvement noted in the group receiving LungTalk (2.33 vs 1.14 mean change). Perceived self-efficacy and perceived benefits improved in the theoretically expected directions.ConclusionsLungTalk goes beyond other decision tools by addressing lung health broadly, in the context of performing a low-dose computed tomography of the chest that has the potential to uncover other conditions of concern beyond lung cancer, to more comprehensively educate the individual, and extends the work of nontailored decision aids in the field by introducing tailoring algorithms and message framing based upon smoking status in order to determine what components of the intervention drive behavior change when an individual is informed and makes the decision whether to be screened or not to be screened for lung cancer.International Registered Report Identifier (IRRID)RR2-10.2196/resprot.8694

Using Implementation Science to Disseminate a Lung Cancer Screening Education Intervention Through Community Health Workers

National lung cancer screening with low dose computed tomography (LDCT) uptake is suboptimal. One factor contributing to slow uptake is lack of awareness. Trained Community Health Workers (CHWs) may be effective in increasing lung cancer screening awareness among disparate populations, however little is known about the processes necessary to scale an intervention for implementation by CHWs in a new area. We examined implementation processes with the RE-AIM framework and pilot tested a CHW-delivered lung cancer education intervention based on the Health Belief Model. We measured pre-post participant knowledge, attitudes and beliefs regarding cancer screening, lung cancer stigma, and intent to obtain LDCT screening. We used community-engaged strategies to collaborate with a local health system, to identify CHWs. CHWs were trained to recruit participants and deliver the one-session lung cancer education intervention. Seven CHWs and eight community sites participated. Participants (n = 77) were female (53%) primarily low income (62.9%); tobacco use was high (36.9%). Post intervention changes in lung cancer screening knowledge (p = < .0001), attitudes regarding lung cancer screening benefit (p = .034) and lung cancer stigma. (p = .024) We learned important lessons that will be useful in subsequent scaling. Collaborating with a local health system is a promising method to disseminate a lung cancer screening education intervention.

Evaluating Knowledge, Attitudes, and Beliefs About Lung Cancer Screening Using Crowdsourcing

Lung cancer screening, despite its proven mortality benefit, remains vastly underutilized. Previous studies examined knowledge, attitudes, and beliefs to better understand the reasons underlying the low screening rates. These investigations may have limited generalizability because of traditional participant recruitment strategies and examining only subpopulations eligible for screening. The current study used crowdsourcing to recruit a broader population to assess these factors in a potentially more general population. A 31-item survey was developed to assess knowledge, attitudes, and beliefs regarding screening among individuals considered high risk for lung cancer by the United States Preventive Services Task Force. Amazon's crowdsourcing platform (Mechanical Turk) was used to recruit subjects. Among the 240 respondents who qualified for the study, 106 (44%) reported knowledge of a screening test for lung cancer. However, only 36 (35%) correctly identified low-dose CT scanning as the appropriate test. A total of 222 respondents (93%) reported believing that early detection of lung cancer has the potential to save lives, and 165 (69%) were willing to undergo lung cancer screening if it was recommended by their physician. Multivariable regression analysis found that knowledge of lung cancer screening, smoking status, chronic pulmonary disease, and belief in the efficacy of early detection of lung cancer were associated with willingness to screen. Although a minority of individuals at high risk for lung cancer are aware of screening, the majority believe that early detection saves lives and would pursue screening if recommended by their primary care physician. Health systems may increase screening rates by improving patient and physician awareness of lung cancer screening.

Promoting Community Awareness of Lung Cancer Screening Among Disparate Populations: Results of the cancer-Community Awareness Access Research and Education Project.

Lung cancer is the no. 1 cause of cancer death in the United States. Racial/ethnic minority and medically underserved populations suffer higher mortality than whites. Early detection through uptake of low-dose computed tomography (LDCT) among screening-eligible adults may mitigate high mortality. However, nearly 5 years since the publication of the US Preventive Services Task Force lung cancer screening guideline, population awareness of LDCT is low, and only 4% of screening-eligible adults have undergone screening. This project used an education intervention to change participants' knowledge, attitudes, and beliefs about cancer risk factors and lung cancer and to connect eligible individuals to LDCT screening and tobacco cessation services. Community-engaged strategies were used to deliver a 4-week educational program in 13 community sites. Trained community health workers delivered the intervention. The intervention was guided by the Health Belief Model. Data were collected by survey to 481 participants; 93% were African American, the majority was female (73.1%), mean age was 58.3 (SD, 10.9) years. There were knowledge increase regarding lung cancer screening (P = .001), a significant decrease in Perceived Severity and Perceived Barriers subscales (P = .001), and an overall increase in response to Perceived Benefits of lung cancer screening and Self-efficacy (P = .001). Fifty-four percent of tobacco users engaged in cessation; 38% of screening-eligible participants underwent LDCT screening. Community health workers are effective in increasing awareness of lung cancer screening and affecting behavior change among disparate populations. Community health workers may have a clinical role in LDCT shared decision making.

Awareness and interest in lung cancer screening among current and former smokers: findings from the ITC United States Survey.

To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States. Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ2 tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents' smoking status. Data were weighed to be representative of the current smoking population in the US. Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)]. Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test.

Race and sex differences in patient provider communication and awareness of lung cancer screening in the health information National Trends Survey, 2013–2017

Despite demonstrated reduction in lung cancer mortality, lung cancer screening uptake has been low. We investigated differences in discussions with physicians about lung cancer screening and awareness using repeated cross-sectional data from three cycles [4.2 (2013); 4.4(2014) and 5.1 (2017)] of the Health Information National Trends Survey. We included 4207 respondents age 55 to 80 who responded to this question: ‘In the past year, have you talked with your doctor about having a test to check for lung cancer?’. We used logistic regression accounting for complex sample weighting to generate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The proportion of participants reporting lung cancer screening discussions was low and did not increase over time. In the most recent cycle, 15.7% of current smokers and 9.9% of former smokers said they had discussed screening. Compared to males, females were 32% less likely to report a lung cancer screening discussion (OR: 0.68, 95% CI: 0.50–0.93) and the association was strongest among non-Hispanic White females. Estimates were similar among never (OR: 0.72, 95% CI: 0.43–1.20), current (OR: 0.73, 95% CI: 0.39–1.36), and former (OR: 0.66, 95% CI: 0.40–1.10) smokers. Females were 32% less likely than males to be aware of a lung cancer screening test (OR: 0.68, 95% CI: 0.47–0.99) and this association was strongest for non-Hispanic Black females (OR: 0.38, 95% CI: 0.19–0.77). Too few providers have discussed lung cancer screening with potentially eligible patients, particularly female patients. Further research is needed to evaluate possible causes for this finding.

Design of a Community-Based Lung Cancer Education, Prevention, and Screening Program.

Uptake of low-dose computed tomography (LDCT) for lung cancer screening is extremely low. Efforts to promote screening are warranted, especially among disparate groups such as racial/ethnic minorities and those of lower socioeconomic status. This article describes the design and implementation strategies of the ongoing cancer-Community Awareness Access Research and Education (c-CARE) program. The purpose of c-CARE is to increase community awareness of lung cancer screening through education. Community health workers were trained to implement the intervention in 12 community sites. The Health Belief Model guided the evaluation and intervention development methods. Aims include changing participants' knowledge, attitude, and beliefs related to lung cancer and increasing lung cancer early detection and prevention behaviors by identifying and connecting high-risk and/or nicotine-dependent individuals to LDCT screening and/or tobacco cessation services. If effective, these methods could model increased dissemination to other high-risk communities.

Lung cancer screening: an emerging cancer control issue presents opportunities for an awareness campaign in rural Michigan.

Lung cancer is the leading cause of cancer deaths in the United States representing about 25% of all cancer deaths. The risk from smoking has increased over time with racial/ethnic minorities and disadvantaged populations having higher smoking rates and experiencing greater burden of lung cancer compared to other populations. Rural populations, in particular, experience higher rates of tobacco usage associated with increased incidence of lung cancer. National efforts to identify lung cancer in its early stage would greatly benefit high-risk populations, consequently reducing advanced cancers and potentially decreasing smoking rates. In 2013, lung cancer screening with low-dose computed tomography was recommended by the US Preventive Services Task Force for early detection of lung cancer. These guidelines were developed after the results of the National Lung Screening Trial. The National Lung Screening Trial study showed a 20% reduction in deaths of participants who were current or former heavy smokers who were screened with low-dose computed tomography versus those screened by chest X-ray. In response to this evidence and using state lung cancer burden data and local smoking rates as a guide, Michigan implemented a lung cancer screening awareness campaign in the rural northern, lower peninsula. Awareness of lung cancer screening was increased through the use of a variety of media including gas station/convenience store small media, digital media, radio broadcast media, and the use and marketing of a website that provided lung cancer screening information and resources.

Abstract 5277: Gender differences in awareness of lung cancer screening in the Health Information National Trends Survey, 2013-2017

Abstract Background: Lung cancer is the leading cause of cancer death in U.S. men and women with just a 17.7% five-year survival rate. Based largely on the results of the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends, and Medicare now covers, low-dose computed tomography for current and former smokers age 55 or older with at least 30 pack-year smoking history. While lung cancer incidence mortality rates are higher in men than women, this is in large part due differences in smoking status. Previous research shows that women worry about breast cancer to a greater extent than lung cancer, and there is a suggestion of greater lung cancer susceptibility in female smokers. We investigated whether there were gender differences in discussions with a doctor about lung cancer screening and awareness of a screening test for lung cancer. Methods: Data are from the three cycles [4.2 (2013); 4.4(2015) and 5.1 (2017)] of the nationally representative Health Information National Trends Survey (HINTS). We included 4,658 respondents age 55 to 80 who responded to the following question: "In the past year, have you talked with your doctor about having a test to check for lung cancer?" and had available data on smoking status and gender. We assessed responses across survey cycles to see if the proportion responding "yes" to this question has increased over time, and whether this differed by gender. We used logistic regression accounting for complex sample weighting to generate adjusted odds ratios (AOR) and 95% confidence intervals (CI) for gender's association with discussion of lung cancer screening with a doctor in HINTS cycles 4.2, 4.4 and 5.1, and with awareness of lung cancer screening tests in cycle 4.4, accounting for potential confounders. Results: Reported discussions with a doctor about lung cancer screening have not increased over time. In the most recent cycle, just 15.7% of current smokers (19.9% of males; 15.7% of females) and 9.9% of former smokers (12.4% of males; 6.9% of females) said they'd discussed screening. Compared to males, females were 32% less likely to report talking to their doctor about lung cancer screening (AOR: 0.68, 95% CI: 0.50-0.93). Estimates were similar among never (AOR: 0.72, 95% CI: 0.43-1.20), current (AOR: 0.73, 95% CI: 0.39-1.36), and former (AOR: 0.66, 95% CI: 0.40-1.10) smokers. Females were also 32% less likely to report that they'd heard of tests for early detection of lung cancer (OR: 0.68, 95% CI: 0.47-0.99) compared to males. Conclusions: Though we are unable to assess pack-years of smoking, we found that irrespective of smoking status (never, current or former), women were less likely to have talked with their doctor about lung cancer screening and were less likely to be aware of lung cancer screening tests. Educational efforts may be needed to ensure that women receive the benefits of this important test. Citation Format: Erica Warner, Christopher S. Lathan. Gender differences in awareness of lung cancer screening in the Health Information National Trends Survey, 2013-2017 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5277.