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Geography is a barrier to lung cancer screening

New analysis: 5% do not have access to lung cancer screening facilities <40 miles.

While lung cancer remains the leading cause of cancer death in the United States and mortality rates are declining, a greater number of deaths could be averted if more adults aged 50-80 at high risk received annual screening to detect the cancer early. A new study, appearing today in Cancer, a peer-reviewed journal of the American Cancer Society (ACS), found approximately 5% of the US population eligible for lung cancer screening, 750,000 adults, do not have access to a lung cancer screening facility within 40 miles. 

The study also observed different patterns of accessibility at different distances, between regions, and rural-urban environments. For example, the proportion of individuals without access to screening in metro counties is only 1.6%, but it is markedly higher among individuals living in rural counties at 24.5%. These percentages translate into approximately 190,000 eligible adults without access in metro counties, but about 280,000 people without access living in rural counties.

“All in all, a larger percentage of the rural population has no access to screening. That’s noteworthy as it translates into a larger number of individuals in rural areas with no access at longer distance thresholds (≥40 miles) compared with urban areas,” said Dr. Liora Sahar, the study leader and GIS Consultant to the American Cancer Society. “Additionally, shorter distances from a screening facility also may represent a formidable barrier for some individuals who are eligible for screening, due to distance, lack of transportation, or the amount of time that would be required to commit to getting screened,” she added. 

Although the study investigators stressed that most individuals who meet the criteria for screening have access within a 40-mile distance, an important observation is that one in four rural residents do not.

“Lung cancer incidence and mortality rates are higher in rural areas, and in most respects, rural populations face greater access to care challenges than urban populations,” noted Dr. Robert Smith, a co-author of the study and senior vice president of Cancer Screening at the American Cancer Society.  “At a time when we are promoting lung cancer screening, it is important to be aware of population areas within a state where access to screening may be a considerable burden or impossible for some adults. At near or far distances, the inability to travel to get health care should not be a barrier,” he added, and warrants attention and creative solutions to ensure that all adults who would benefit from lung cancer screening can receive annual exams.” 

Annual lung cancer screening with low dose computed tomography (LDCT) has been recommended by the American Cancer Society and other organizations since 2014 and covered by private insurance and Medicare since 2015. However, to date, the uptake of lung cancer screening has been low, primarily due to the challenge of identifying high-risk adults, the complexity of the referral process, and other access-to-care barriers.

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