Uptake Of Lung Cancer Screening Research Articles

Abstract A116: Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation

Abstract Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low (<6%). Black and low-income Americans have higher lung cancer mortality rates and lower lung cancer screening rates than White and high-income Americans, respectively. Lower lung cancer screening uptake among Black and low-income populations may widen existing disparities in lung cancer mortality. Prior studies have found higher levels of medical mistrust among Black and low-income populations, perhaps arising from structural racism and other inequities. Indeed, medical mistrust may reduce cancer screening intentions, but little is known about how health systems can promote lung screening uptake while earning patient trust. To address this gap, this study aimed to identify diverse patient perspectives on increasing equity in lung screening uptake and addressing medical mistrust. Methods: We conducted 20 semi-structured interviews and four focus groups (about four participants per group) with a diverse sample of lung cancer screening-eligible individuals throughout the U.S. (i.e., individuals aged 50-80 years with eligible smoking histories). Interviews and focus groups investigated participant awareness of lung screening, barriers to screening, the role of medical mistrust in screening uptake, and perspectives on equitable screening implementation. We used an iterative inductive/deductive content analysis approach to identify key themes from interview and focus group transcripts. Results: Interview participants (n=20) were 60 years of age on average and had a mean smoking pack-year history of 42.5 years. Half of interview participants identified as Black (50%), slightly more than half of participants had a household income of <$30,000 (55%), and most participants were female (60%). Focus group participants had similar demographics. Most participants were unaware of lung cancer screening but were eager to learn more. As a key barrier, participants discussed that their doctors had never mentioned lung screening, which confused and frustrated participants who had long-term relationships with primary care doctors. Prior negative healthcare experiences (e.g., misdiagnoses and having serious symptoms dismissed by healthcare providers) were also discussed as screening barriers as they engendered mistrust and hesitancy to seek future care. Several Black participants cited personal and vicarious experiences of racism in the healthcare system as key barriers contributing to mistrust and screening hesitancy. Lastly, participants raised several suggestions to promote equitable screening implementation, such as the need to meaningfully engage with communities to raise screening awareness and address cost issues. Conclusions: Lung cancer screening interventions may be more successful if concerted efforts are taken to understand and address medical mistrust. Future work is needed to address the reasons patients may mistrust healthcare providers and systems that deliver lung cancer screening. Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.

Barriers and facilitators for low-dose computed tomography lung cancer screening in rural populations in the United States: a scoping review protocol.

The objective of this scoping review is to identify barriers and facilitators for low-dose computed tomography lung cancer screening uptake and adherence among rural populations in the United States. Lung cancer is the leading cause of cancer-related death in the United States, and cancer patients from rural areas have poorer outcomes than those from metropolitan areas. Evidence exists that lung cancer screening by low-dose computed tomography significantly increases survival time but is also significantly underutilized. Studies completed in the United States with adults who fit United States Preventive Services Task Force guidelines for lung cancer screening and who live in rural areas will be included. Studies published in English since 2013 that report on barriers and facilitators for low-dose computed tomography lung cancer screening uptake and adherence will be included in this review. Quantitative, qualitative, or mixed-methods studies will be included, along with opinion pieces published by government agencies or professional cancer-related organizations. The search strategy will locate published primary studies, reviews, and opinion papers, including those by government and nonprofit agencies focused on cancer. The databases to be searched include MEDLINE, CINAHL Complete, Embase, Web of Science, and Cochrane Library. Gray literature databases and sources of unpublished studies will also be searched. Independent reviewers will be used throughout the search and selection process.

Lung Cancer Screening Knowledge, Attitudes, and Practice Patterns Among Primary and Pulmonary Care Clinicians.

Lung cancer screening has the potential to identify lung cancer at an early stage when more treatment options exist. However, discussions with and referrals of screening-eligible patients remain unacceptably low. We need to better understand clinician knowledge, attitudes, and practice patterns to identify strategies to improve lung cancer screening uptake. Prior studies have focused on understanding these factors from physicians only. Nevertheless, many patients receive primary care from nurse practitioners and physician assistants where prevention and early detection conversations are most likely to occur. Therefore, we must engage the full range of clinicians treating screening-eligible patients. The aim of this study was to describe attitudes, beliefs and referral practice patterns, lung cancer screening knowledge, and concordance with lung cancer screening guidelines among nurse practitioners, physicians, and physician assistants in the United States. A descriptive, cross-sectional study was performed using survey methodology with clinical vignettes to examine clinician factors and concordance with U.S. Preventive Services Task Force lung cancer screening guidelines. Participants scored low on attitudes toward shared decision-making, high on the importance of shared decision-making in lung cancer screening, and low on barriers to lung cancer screening referral. In addition, midrange scores on empathy toward patients with smoking history were noted. Lung cancer screening knowledge was low regardless of clinician specialty; the most endorsed response when presented with a hypothetical patient was to refer for lung cancer screening using a chest X-ray. Findings demonstrate that most clinicians are nonconcordant with U.S. Preventive Services Task Force guidelines, erroneously believing a chest X-ray is appropriate for lung cancer screening. Clinicians must follow evidence-based practice guidelines, highlighting the need for targeted continuing education about lung cancer screening for clinicians who treat screening-eligible patients.

Motivation is not enough: A qualitative study of lung cancer screening uptake in Australia to inform future implementation.

IntroductionParticipation in lung cancer screening (LCS) trials and real-world programs is low, with many people at high-risk for lung cancer opting out of baseline screening after registering interest. We aimed to identify the potential drivers of participation in LCS in the Australian setting, to inform future implementation.MethodsSemi-structured telephone interviews were conducted with individuals at high-risk of lung cancer who were eligible for screening and who had either participated (‘screeners’) or declined to participate (‘decliners’) in the International Lung Screening Trial from two Australian sites. Interview guide development was informed by the Precaution Adoption Process Model. Interviews were audio-recorded, transcribed and analysed using the COM-B model of behaviour to explore capability, opportunity and motivation related to screening behaviour.ResultsThirty-nine participants were interviewed (25 screeners; 14 decliners). Motivation to participate in screening was high in both groups driven by the lived experience of lung cancer and a belief that screening is valuable, however decliners unlike their screening counterparts reported low self-efficacy. Decliners in our study reported challenges in capability including ability to attend and in knowledge and understanding. Decliners also reported challenges related to physical and social opportunity, in particular location as a barrier and lack of family support to attend screening.ConclusionOur findings suggest that motivation alone may not be sufficient to change behaviour related to screening participation, unless capability and opportunity are also considered. Focusing strategies on barriers related to capability and opportunity such as online/telephone support, mobile screening programs and financial assistance for screeners may better enhance screening participation. Providing funding for clinicians to support individuals in decision-making and belief in self-efficacy may foster motivation. Targeting interventions that connect eligible individuals with the LCS program will be crucial for successful implementation.

EP01.01-003 DELFI-L101: Development of a Blood-Based Assay That Evaluates Cell-Free DNA Fragmentation Patterns to Detect Lung Cancer

Uptake of lung cancer screening is low worldwide, including in the US despite established recommendations and national reimbursement for eligible persons. Studies show that screening by low-dose computed tomography (LDCT) can reduce mortality, but the benefits of screening are challenged by barriers that include access to screening, costs, and harms like false-positives and radiation exposure. A tool that can separate the screening-eligible population into groups with higher and lower risk of lung cancer could allow more judicious use of LDCT screening.

P1.12-01 Lung Cancer Screening in the COVID-19 Era: Understanding Program-Level Impact

Lung Cancer Screening (LCS) via Low Dose Computed Tomography (LDCT) reduces lung cancer mortality, yet utilization has remained low even before the onset of the COVID-19 pandemic and the resulting disruption to screening (Aberle et al., 2011; de Koning et al., 2020; Jemal, 2017). The impact of COVID-19 on specific LCS program components and how this has led to differences in LCS uptake is unknown. Understanding program-level barriers experienced in the context of COVID-19 will help guide resource allocation and inform optimization of LCS in the future.

Facilitators and Barriers to Implementation of Lung Cancer Screening: A Framework-Driven Systematic Review.

The purpose of this study is to undertake a comprehensive systematic review to describe multilevel factors (barriers and facilitators) that may influence the implementation of low-dose chest computed tomography for lung cancer screening in the United States. Systematic literature searches were performed using 6 online databases and citation indexes for peer-reviewed studies, for articles published from 2013 to 2021. Studies were classified into 3 perspectives, based on the study's unit of analysis: system, health-care provider, and patient. Barriers and facilitators identified for each study included in our final review were then coded and categorized using the Consolidate Framework for Implementation Research domains. At the system level, the 2 most common constructs were external policy and incentives and executing the implementation process. At the provider level, the most common constructs were evidence strength and quality of the intervention characteristics, patient needs and resources, implementation climate, and an individual's knowledge and beliefs about the intervention. At the patient level, the most common constructs were patient needs and resources, individual's knowledge and beliefs about the intervention, and engaging in the implementation process. These constructs can act as facilitators or barriers to lung cancer screening implementation. Applying the Consolidate Framework for Implementation Research domains and constructs to understand and specify factors facilitating uptake of lung cancer screening as well as cataloging the lessons learned from previous efforts helps inform the development and implementation processes of lung cancer screening programs in the community setting. PROSPERO, CRD42021247677.

Uptake of lung cancer screening with low-dose computed tomography in China: A multi-centre population-based study.

SummaryBackgroundOptimal uptake rates of low-dose computed tomography (LDCT) scans are essential for lung cancer screening (LCS) to confer mortality benefits. We aimed to outline the process model of the LCS programme in China, identify the high-risk individuals with low uptake based on a prospective multi-centre population-based cohort, and further explore associated structural characteristics.MethodsA total of 221,955 individuals at high-risk for lung cancer from the National Lung Cancer Screening cohort were included. The logistic regression model was performed to identify the individual characteristics associated with the uptake of LCS, defined as whether the high-risk individual undertook LDCT scans in designated hospitals within six months following the initial risk assessment. The linear regression model was adopted to explore the structural characteristics associated with the uptake rates in 186 communities.FindingsThe overall uptake rate was 33·0%. The uptake rate was negatively correlated with the incidence of advanced-stage lung cancer (Pearson's coefficient −0·88, p-value 0·0007). Multivariable regression models found that lower uptake rates were associated with males (OR 0·88, 95%CI 0·85–0·91), current smokers (OR 0·93, 95%CI 0·90–0·96), individuals with depressive symptoms (OR 0·92, 95%CI 0·90–0·94), and the structural characteristics, including longer structural delays in initiating LDCT scans (30–90 days vs. ≤14 days: β −7·17, 95%CI −12·76∼ −1·57; >90 days vs. ≤14 days: β −13·69, 95%CI −24·61∼ −2·76), no media-assisted publicity (β −6·43, 95%CI −11·26∼ −1·60), and no navigation assistance (β −5·48, 95%CI −10·52∼ −0·44).InterpretationMultifaceted interventions are recommended, which focus on poor-uptake individuals and integrate the ‘assessment-to-timely-screening’ approach to minimise structural delays, media publicity, and a navigation assistance along the centralised screening pathway.FundingMinistry of Finance and National Health Commission of the People's Republic of China.

DELFI-L101: Development of a blood-based assay that evaluates cell-free DNA fragmentation patterns to detect lung cancer.

TPS3164 Background: Despite longstanding national recommendations, uptake of lung cancer screening in the US remains low. Barriers include access to lung cancer screening, costs, and concerns over potential harms like false-positives and radiation exposure. The DELFI technology evaluates fragmentation patterns of cfDNA using supervised machine learning to distinguish cancer from non-cancer [PMID30943338; 34417454; 31142840]. Methods: The DELFI-L101 is a case-control observational study (NCT04825834) prospectively enrolling at academic and community sites. Eligible participants (≥50 years of age) are individuals who currently smoke or previously smoked, with smoking histories of ≥20 pack-years. Individuals are ineligible if they had cancer treatment in the prior year or a history of hematologic malignancies or myelodysplasia. Cases are individuals with pathologically confirmed cancers (group A – lung, group C – non-lung). Controls are those without cancer (group B) as determined by low-dose computed tomography screening completed within 6 weeks of enrollment. Cases and controls are identified among enrollees from all participating sites. Total enrollment is estimated to be ̃2500 participants across all groups. Blood samples are collected at enrollment for DELFI analyses, which involves cfDNA isolation from plasma, low-coverage, whole-genome, next-generation sequencing, and machine learning methods. Clinical data (medical history, demographics, and diagnostic, surgery, imaging, and pathology reports, and/or other diagnostic information) are collected at enrollment and at 12 months post-enrollment. The primary objective is to train and test a classifier for the detection of lung cancer using the DELFI technology with other biomarkers and clinical features. Secondary objectives include the evaluation of classifiers to distinguish lung cancer from other cancers, modeling benefits and harms using performance estimates of these classifiers, and description of the analytical performance (eg, repeatability and reproducibility) of the DELFI technology and classifiers. The primary endpoint is the accuracy of lung cancer detection as measured by sensitivity, specificity, and the area under the receiver operating characteristic curve. Secondary endpoints include accuracy of tissue of origin classification, and adverse events associated with blood sample collection. The training and performance characterization of a DELFI classifier will further the development of an affordable, accessible, blood-based cancer detection tool with potential to overcome barriers to lung cancer screening. Clinical trial information: NCT04825834.

Implementing physician education to increase lung cancer screening uptake.

Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. The US Preventive Services Task Force and National Comprehensive Cancer Network recommend annual low-dose computed tomography (LDCT) for eligible adults. We conducted a study to assess physician LDCT referral patterns. The study was divided into a pre-, intervention, and post-intervention periods. The intervention was a LC screening educational series. We evaluated rates of LDCT screening referrals during pre- and post-intervention periods. In the pre-intervention period, 75 patients fulfilled US Preventive Services Task Force and/or National Comprehensive Cancer Network criteria and 27% underwent LDCT. In the post-intervention period, 135 patients fulfilled either screening criteria of whom 61.5% underwent LDCT. In our study, educational lectures improved compliance significantly and should be used as tool for primary care providers to effectively increase LDCT screening referrals.

Barriers and facilitators of lung cancer screening uptake: protocol of a mixed methods systematic review.

IntroductionThe global uptake rates of lung cancer screening (LCS) with low-dose CT remain low. Since numerous factors contribute to the underuse of LCS, a theory-informed approach to identify and address the uptake of LCS barriers and facilitators is required. This study aims to document the methods which were used to identify, appraise, and synthesise the available qualitative, quantitative, and mixed methods evidence, addressing the barriers and facilitators at the individual and healthcare provider level, according to the social–ecological model, before identifying gaps to aid future practices and policies.Methods and analysisThe following databases will be searched: PubMed, Ovid (Journals @ Ovid Full Text and Ovid MEDLINE), EMBASE, CINAHL, PsycINFO, Cochrane Library, Chinese Biomedical Database, Chinese National Knowledge Infrastructure, and Wanfang database, from their creation up to 31 December 2020. Two reviewers will be involved in independently screening, reviewing, and synthesising the data; and calibration exercises will be conducted at each stage. Disagreements between the two reviewers will be resolved by arbitration by a third reviewer. The Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute, the Critical Appraisal Skills Programme criteria adapted for qualitative studies, and the 16-item Quality Assessment Tool (QATSDD) will be used in the quality assessment of primary studies. We will perform data synthesis using the Review Manager software, V.5.3.Ethics and disseminationThis study is a review of published data and therefore needs no ethical approval. The findings of this systematic review will be published in a peer-reviewed journal.Trial registration numberCRD42020162802.

Abstract PO-262: Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study

Abstract Background: Lung cancer screening (LCS) with low-dose CT can reduce mortality due to lung cancer by detecting early-stage tumours that are amenable to treatment. Participation in LCS programs however has not been equally distributed among at-risk groups, such that populations with the highest burden of lung cancer risk (through the social patterning of smoking behaviour) and lowest levels of healthcare utilization (through care which is structurally inaccessible) can experience a widening in healthcare disparities as a result of LCS interventions. Approach: We sought to inform equitable access to LCS by illuminating knowledge and implementation gaps in current interventions designed to increase the uptake of LCS. To do this, we conducted a scoping study using the Arksey and O'Malley methodological framework. We conducted comprehensive searches for lung cancer screening promotion interventions (Ovid Medline, Embase, the Cochrane Library, CINAHL and Scopus) and included published English language peer-reviewed and grey literature published between January 2000 and 2020 that describe an intervention designed to increase the uptake of LDCT lung cancer screening in the Organization for Economic Cooperation and Development (OECD) countries. We extracted data onto a chart modified from the Template for Intervention Description and Republication (TIDieR) checklist and the Consolidated Standards of Reporting Trials. We used the Health Equity Impact Assessment (HEIA) tool to analyse the intended/unintended and positive/negative outcomes of the interventions for populations experiencing the greatest disparities. Results: Our search yielded 2681 articles. We included 22 peer review articles dated from January 2000 to January 2020. Interventions occured primarily in the USA, Europe and Canada. We used the ‘Patient Centered Access to Healthcare' conceptual framework by Khanassov et al 2016 to synthesize our findings. Three main themes summarise current interventions designed to increase the uptake of LCS: (i) a focus on individuals and their ability to engage with the healthcare system; (ii) inadequate targeting of populations experiencing greatest disparities and (iii) a lack of conceptual underpinning in the design of interventions so that the social patterning of lung cancer risk and ability to access care is ignored. Conclusion: LCS interventions must take into consideration the disproportionate burden of lung cancer risk in populations experiencing social disadvantage. Designing interventions that are cognisant of the social distribution of risk and targeted to support the uptake in high-risk populations can prevent an inadvertent widening of health disparities. Citation Format: Ambreen Sayani, Muhanad Ahmed Ali, Pooja Dey, Ann Marie Corrado, Carolyn Ziegler, Alex Sadler, Christina Williams, Aisha Lofters. Interventions designed to increase the uptake of lung cancer screening and implications for populations experiencing the greatest burden of lung cancer disparities: A scoping study [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-262.

Predictors of Discussing Lung Cancer Screening with a Health Care Provider Among Current and Former Smokers in HINTS: A Secondary Data Analysis.

IntroductionLung cancer screening is greatly underutilized among those who may benefit from early detection.MethodsWe analysed data from a subsample (n = 929) of the 2020 Health Information National Trends Survey. We tested multivariable logistic regression models of associations of cancer worry, information insufficiency, and perceived information gathering capacity with reports of having discussed lung cancer screening with a health care provider.ResultsAmong former smokers, no factors were associated significantly with lung cancer screening information seeking. However, for current smokers, extreme cancer worry was positively and significantly associated with having discussed lung cancer screening with a health care provider (OR: 12.95; 95% CI: 2.11, 79.39).ConclusionTo increase uptake of lung cancer screening, public health campaigns and healthcare providers will face the dual challenge of increasing perceived need for screening among former smokers while directing current smokers with high levels of worry to see the benefits of early detection.

Abstract PO-268: Investigating patient barriers to low-dose computed tomography lung cancer screenings among the African American population

Abstract Background Lung cancer remains the leading cause of cancer death in the United States. Lung cancer screening (LCS) with Low-Dose Computerized Tomography (LDCT) has been found to reduce lung cancer mortality up to 26% and all-cause mortality by 7%. Yet, uptake of LCS is less than 4% among those eligible. African Americans (AAs) have the highest cancer mortality rate and are also more likely to die of lung cancer compared to whites. Furthermore, little research has been done to understand this groups in terms of their knowledge, awareness, and perceptions related to LCS, and the potential barriers or facilitators to LCS. Guided by the Health Believe Models, this study aims to examine the demographic, behavioral, and psychosocial profiles related to LCS in AAs, and identify the predictors to the uptake of LCS with LDCT. Methods We have recruited 200 AA patients eligible for LDCT for a case-control cohort (100 AAs who have completed a LDCT screening and 100 who did not) through the electric medical record of a safety-net hospital. We are currently conducting online and telephone surveys to collect information on participants' personal and family history, health literacy, beliefs, psychosocial factors, patient-provider relationship, knowledge of lung cancer, perception of screening and potential care cost, transportation barriers, and racial discrimination. Results We will conduct descriptive analysis of the sociodemographic characteristics and the modifiable lifestyle behaviors of the participants separately for those who completed LDCT and those who did not. We will then conduct bivariate analysis (chi-square and t-test) to compare various psychosocial and health-related factors by LDCT completion status. Finally, we will conduct binary logistic regression to examine the association between the predictors and LDCT completion. Conclusion The findings of this study will provide critical empirical evidence on the psychosocial facilitators and barriers to LDCT uptake among AAs, a vulnerable and medically underserved population. The facilitators and barriers identified in this study will be used to design both clinic-based and community-based behavioral intervention studies to promote LDCT uptake among eligible AAs. Citation Format: Alexander Nguyen, Lin Zhu, Ra'Ann Merceir, Grace X Ma, Cherie P Erkmen. Investigating patient barriers to low-dose computed tomography lung cancer screenings among the African American population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-268.

Abstract IA-49: Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system

Abstract Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and many AI/AN communities have worse lung cancer incidence rates, survival, and death compared to the general population. Although lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation, uptake of LCS has been slow in most healthcare systems. LCS implementation among AI/AN has not been studied before in detail. To address this knowledge and implementation gap, a multi-phase, 5-year “Tribally Engaged Approaches to Lung Screening" (TEALS) study was launched in 2019 in partnership with the Choctaw Nation of Oklahoma. The overarching goal of this project is to co-design and test an LCS implementation program. This presentation will discuss what is being learned about potential facilitators and barriers to implementing LCS in a tribal health care setting. Findings may be pertinent to other health systems serving tribal, rural or underserved populations. Citation Format: Zsolt J. Nagykáldi. Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-49.

Preferred Lung Cancer Screening Modalities in China: A Discrete Choice Experiment.

Simple SummaryFew results from public attitudes for lung cancer screening are available both in China and abroad. The aims of this study were to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. Preferred screening modality in this study was inconsistent with current Chinese practice. Screening interval was the main determinant of preferred lung cancer screening modality in both the general respondents and in subgroups, this poses a considerable challenge to the implementation of a sustainable, regular screening programme. In addition, those with no endowment insurance were more likely to opt out; indicating that a promotion of financial support is needed to reduce inequalities of attendance of disadvantaged elderly.This study aimed to identify preferred lung cancer screening modalities in a Chinese population and predict uptake rates of different modalities. A discrete choice experiment questionnaire was administered to 392 Chinese individuals aged 50–74 years who were at high risk for lung cancer. Each choice set had two lung screening options and an option to opt-out, and respondents were asked to choose the most preferred one. Both mixed logit analysis and stepwise logistic analysis were conducted to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. On mixed logit analysis, attributes that were predictive of choice at 1% level of statistical significance included the screening interval, screening venue, and out-of-pocket costs. The preferred screening modality seemed to be screening by low-dose computed tomography (LDCT) + blood test once a year in a general hospital at a cost of RMB 50; this could increase the uptake rate by 0.40 compared to the baseline setting. On stepwise logistic regression, those with no endowment insurance were more likely to opt out; those who were older and housewives/househusbands, and those with a health check habit and with commercial endowment insurance were less likely to opt out from a screening programme. There was considerable variance between real risk and self-perceived risk of lung cancer among respondents. Lung cancer screening uptake can be increased by offering various screening modalities, so as to help policymakers further design the screening modality.

Lung cancer screening primer: Key information for primary care providers.

To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. A new, large randomized controlled trial has been published since 2016, as have updates from 4 other trials. PubMed was searched for studies published between January 1, 2004, and December 31, 2020, using search words including lung cancer screening eligibility, lung cancer screening criteria, and lung cancer screening guidelines. All information from peer-reviewed articles, reference lists, books, and websites was considered. Lung cancers diagnosed at stage 4 have a 5-year survival rate of only 5% and have a disproportionate impact on those with lower socioeconomic status, rural populations, and Indigenous populations. By downstaging, or diagnosing lung cancers at an earlier and more treatable stage, lung cancer screening reduces mortality with a number needed to screen of 250 to prevent 1 death. Practical aspects of lung cancer screening are reviewed, including criteria to screen, appropriate low-dose computed tomography screening, and management of findings. Harms of screening, such as overdiagnosis and incidental findings, are discussed to allow PCPs to appropriately counsel their patients in the face of ongoing implementation of new lung cancer screening programs. Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.

Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study

IntroductionLow uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. MethodsThis is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55–77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study—a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs’ associations with uptake (telephoning for an appointment) and sociodemographic characteristics. ResultsHigher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. ConclusionsInterventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high.

Abstract LB219: Methods to improve representation of racial and ethnic minorities in lung cancer screening programs: A systematic review

Abstract Background: Most lung cancer screening trials to date and current screening guidelines overlook vulnerable populations with disproportionate lung cancer burden such as racial and ethnic minorities. Given the barriers, perceptions, and socioeconomic burden of these underserved populations, uptake of lung cancer screening has minimal. To develop and implement better methods of recruitment underserved populations, concerted efforts to understand the barriers and perceptions of these population are needed. Objective: Conduct a systematic review of methods for recruitment of racial and ethnic minorities into lung cancer screening trials or programs. Methods: We searched for studies that reported methods of recruitment and racial and ethnic minorities into lung cancer screening from 2010 to June 2020, using Ovid MEDLINE and Embase databases. Full-text screening and data extraction were completed independently by two reviewers and adjudication was performed by a third, independent reviewer. We compared referral rates of the recruitment modalities by racial/ethnic subgroups and by sex. Results: We identified 525 studies of which 25 were included in the systematic review corresponding to 291,329 patients. The most frequent methods of recruitment were referral, physical mail, community-based strategies, targeted strategies, phone, advertisement, and social media. Referral (n=7; 2,510 patients) was the most effective method of recruitment with response rates ranging from 31% to 97%. Direct mail (n=8 studies; 189,799 patients) was the second most extensively used recruitment method with response rates of 28% to 79%. Direct mail to Hispanic patients (2,995 total) for lung cancer screening programs was more effective than other methods of recruitment. Direct mail was more effective in recruiting African American patients (8,331 total) compared to referral (1,083 total). Conclusion: This review identified recruitment modalities that were more successful and less unsuccessful in recruiting racial and ethnic minorities into lung cancer screening trials and programs. This work highlights priorities and next steps required to improve recruitment of racial and ethnic minorities in lung cancer screening. There is a need to develop culturally relevant lung cancer screening interventions for Hispanics/Latino patients and to create targeted intervention for African American patients. Citation Format: Tiffany J. Gilliard, Jaileene Perez-Morales, Matthew Schabath, Mary Katherine Haver. Methods to improve representation of racial and ethnic minorities in lung cancer screening programs: A systematic review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB219.

Understanding factors associated with uptake of lung cancer screening among individuals at higher risk.

10559 Background: Lung cancer is the leading cause of cancer death in the U.S, accounting for about 25% of all cancer mortality. The U.S Preventive Services Task Force has recommended annual screening for lung cancer using low-dose computed tomography (LDCT) scanning for individuals at higher risk (aged 55-80 years with a >30 pack-year smoking history). Early detection using LDCT scanning reduces lung cancer specific mortality by 20%. Despite its efficacy, the uptake of annual lung cancer screening among high-risk individuals remains low ( < 18%). The purpose of this study was to identify factors associated with the uptake of lung cancer screening in high-risk individuals in the U.S population. Methods: Data for this study were obtained from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), a population-based survey conducted annually by the Centers for Disease Control and Prevention (CDC) in collaboration with health departments in all 50 states, Washington, DC, and the U.S territories. We restricted our sample to high-risk individuals aged 55-80 years with a >30 pack-year smoking history. Only subjects with complete data on all predictor variables (age, gender, race/ethnicity, marital status, education, income, insurance, COPD, current smoking status, primary care provider) and the outcome variable (uptake of lung cancer screening) (n = 11, 714) were included in the final analysis. Chi-square tests were used to compare the uptake of lung cancer screening by demographic and socioeconomic factors. Multivariable logistic regression models were used to model the association between the predictors and the outcome variable. Results: Individuals with no health insurance (OR: 0.64; 95%CI: 0.46-0.90), no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), no chronic obstructive pulmonary disease (COPD) (OR: 0.35; 95%CI: 0.31-0.0.40) and who were females (OR: 0.86; 95%CI: 0.76-0.96) were less likely to participate in annual lung cancer screening. Individuals aged 65–69 years (OR: 1.65; 95%CI: 1.38-1.97), 70–74 years (OR: 1.77; 95%CI: 1.46-2.14) or 75–80 years (OR: 1.42; 95%CI: 1.16-1.76) were more likely to receive annual lung cancer screening compared with those aged 55-59 years. Race/ethnicity, level of education, level of income, marital status, and current smoking status had no significant association with the uptake of annual lung cancer screening. Conclusions: Our study identifies factors associated with lower uptake of annual lung cancer screening (no health insurance coverage, no primary healthcare provider, no COPD, and female gender). The findings from this study have important implications for the design of more effective interventions to target specific subgroups for the uptake of annual lung cancer screening.