How can screening help address disparities in lung cancer?

Lung cancer is the leading cause of cancer-related deaths, yet disparities in lung cancer rates mirror overall social and health-system inequities. Striving to provide equitable access to screening is a key part of closing the gap.
 

Lung cancer: an inequitable disease

Lung cancer accounts for 1 in 5 cancer-related deaths – but this burden is not felt equitably.

Often, the inequities we see in society more generally are mirrored in health outcomes. Case in point: higher rates of lung cancer are observed in underserved population groups who – for many reasons – face barriers to accessing best-practice care.

For example, in Aotearoa New Zealand, Māori experience significantly higher rates of lung cancer and poorer outcomes. And in the UK, lower socioeconomic position is associated with higher rates of lung cancer, which can largely attributed to higher smoking rates.

Earlier detection of lung cancer, achieved via low-dose computed tomography (LDCT)  screening, offers an opportunity to detect lung cancer earlier, with strong evidence that this improves outcomes from the disease. There is an ongoing emphasis on screening for lung cancer to detect the disease earlier and, ultimately, improve outcomes. But screening programmes are not implemented everywhere, so many communities at high risk of lung cancer lack access to this opportunity.
 

What are the inequalities impacting access to screening?

The factors contributing to barriers in access to screening are complex, for example:

• Awareness of and knowledge about lung cancer varies across communities. Limited understanding of the disease can contribute to stigma – which persists particularly due to its association with smoking and can influence whether and how people interact with screening services.
• Information provided about screening is often not accessible or designed to meet the needs of those invited for screening, such as in appropriate languages and formats, or delivered by a trained healthcare professional.
• The practicalities of attending screening can reduce uptake of a screening invitation – such as working hours, or proximity to a screening location.

Action to reduce disparities in screening

Action to achieve equitable access and uptake of screening is being taken, providing examples and lessons for other programmes to learn from:

• In Aotearoa New Zealand, different screening invitation models are being trialled to understand which are more effective in securing uptake among Māori, who are disproportionately affected by lung cancer.
• Dedicated navigators are trained to provide information to those eligible for screening, offering them the opportunity to ask questions about the process and increase their understanding of screening, to support informed decision-making.
• In Australia and England, mobile CT scanners allow easier access for people in rural communities, who may otherwise have to travel long distances to access screening.

By taking action to ensure that all those at risk are able to participate in screening programmes, disparities can be addressed. This has been demonstrated in England’s UK Lung Cancer Screening Trial, where equitable uptake across socioeconomic groups was achieved, and disparities in outcomes reduced.

Screening offers a critical opportunity to detect lung cancer earlier. Programmes must be designed with the needs of all eligible people in mind, so everyone who is at risk of lung cancer can benefit from participating. There are ever more examples of how equity is being achieved in a variety of settings, and we see positive results when it is placed front and centre.