Monday, June 17, 2024
HomeHealthRacial Disparities in Lung Cancer Screening

Racial Disparities in Lung Cancer Screening

Ayanay Ferguson knew something was wrong with her body when she returned from vacation with her husband in April 2021.

“My ankles were swollen and I was short of breath,” recalled Ferguson, 50, a clinical psychologist in the Atlanta area.

She initially thought her symptoms were due to post-vacation fatigue and her weight. As his symptoms persisted, he scheduled a telehealth appointment with a doctor, who advised him to have his heart checked. A EKG in a nearby hospital emergency room returned to normal, but a resident doctor was concerned enough about some of his lab results to investigate him further.

“He said he had just read an article about how that particular blood test wasn’t raising levels in African Americans, when in fact there was a problem, and that’s what kept him looking for things,” Ferguson recalled. “That’s why he ordered a chest CT scan.”

The CT scan showed what was later discovered to be a cancerous mass in his right lung. The diagnosis: stage 3Anon-small cell adenocarcinoma. “I had cancer cells in some of my lymph nodes,” she says.

Read: Understanding the different types of lung cancer >>

The lung cancer diagnosis came as a shock to Ferguson, who had never smoked cigarettes and had no family history of the disease, but he accepted the aggressive treatment plan ordered by his thoracic surgeon. The plan was for him to undergo surgery to remove the mass and four rounds of chemotherapy. Three years later, Fergurson proudly reports that he is cancer-free.

A growing body of research reveals that as a black person, you are especially lucky to have defeated the disease that kills. more than 125,000 Americans per year: more than breast, colon and prostate cancers combined. Lung cancer is more difficult to treat in its advanced stages, so early detection through screening greatly increases a person’s chances of survival. However, racial disparities exist.

Studies have found that patients with black lung cancer were 15% less likely than white patients to be diagnosed early and had the lowest five-year survival rate of any racial group. Black Americans tended to develop lung cancer at higher rates and at younger ages than their white counterparts, despite smoking fewer cigarettes on average. According to the American Lung Association, the disease claimed the lives of more than 14,000 African Americans in 2021, the most recent year for available data.

Addressing persistent disparities in early lung cancer diagnosis and survival rates is central to the work carried out by Dr. Melinda Aldrich, associate professor at Vanderbilt University Medical Center. He 2019 groundbreaking study co-authored with five colleagues found that screening eligibility guidelines exclude black smokers more than other people of other races. The health industry has been slow to respond to the growing push to change that, including health insurance companies that determine what is considered preventive care and what is covered at little or no cost.

Aldrich’s research found that the U.S. Preventive Services Task Force (USPSTF), the government group that sets screening guidelines, required that a person be between 55 and 80 years old and have smoked the equivalent of a pack a day. day for 30 years to qualify. for a life-saving early detection test known as low-dose CT scan. In addition to these criteria, a person must be a current or former smoker, and former smokers must have quit smoking within the previous 15 years. Aldrich’s analysis of more than 84,000 adult smokers revealed that, by that criterion, black patients at relatively high risk of lung cancer were being disproportionately excluded from the eligible testing pool. More than 2 in 3 black smokers diagnosed with lung cancer did not meet criteria for age and smoking history at the time of diagnosis.

“Based on those guidelines, we saw that of the people who were diagnosed with lung cancer, 68% of African Americans… would not have been eligible for lung cancer screening. And this contrasts with the 44% of white Americans who would not be eligible,” he said. “Therefore, strong racial disparities (exist) in terms of eligibility and who can come in for testing.”

The work of Aldrich and his co-authors was cited in a 2021 decision by the USPSTF to make two changes that have nearly doubled the number of people eligible for lung cancer screening: lowering the age from 55 to 50 and reducing the number of smoking history. pack years from 30 to 20.

“They didn’t do exactly what we proposed: something that could be considered controversial, which is to make a breed-specific change to the guidelines,” he said. “They made the changes to the guidelines for everyone. So, in reality, disparities persist. “They just made more people eligible.”

Aldrich said raising awareness about the screening test that has been widely available for more than a decade is critical to helping improve outcomes and survival rates for lung cancer patients, especially Black patients. Still, he said, the medical industry needs to answer the call to take another step to allow more people to qualify for early screening based on additional risk factors, such as race, ethnicity and family history. “If you have a history of smoking, talk to your doctor about whether you are eligible for lung screening,” Aldrich said. “We also need to eliminate the stigma associated with smoking; “We should unite the community instead of associating blame.”

Ferguson said that although changes to race-specific screening guidelines probably wouldn’t have helped her case as a non-smoker, she supports the change to expand testing eligibility. “I don’t care if you’re 30 or 70. If you smoked every day for 10 years or more, you should be able to say to your doctor, ‘I want a lung cancer screening,’ and get it done,” she said. “It’s money spent at the beginning and money saved at the end. And most importantly, it will save more lives.”

This educational resource was created with the support of Merck.

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