Abstract C89: Lung cancer screening in high risk populations: Developing community based screening and navigation program
Authors: Pasquinelli Mary , Watson Karriem , Grumeretz Scott , Feldman Lawrence E. , Kovitz Kevin , Dudek Arkadiusz Z. , Menchaca Martha , Koshy Matthew , Winn Robert 
Published: March 2017

Purpose: The National Lung Cancer Screening Trial (NLST) resulted in a 20% reduction in lung cancer (LC) deaths and 6.7% reduction in all-cause mortality. The NLST also resulted in lung cancer screening guidelines from the USPSTF. The population of the NLST was 91% white with less than 5% African Americans (AA) in the trial. AA are known to carry greatest burden of incidence/mortality due to LC. There is little data on populations such as the UI Health population who are predominantly AA with varied smoking behaviors.

Objective: We examined lung cancer screening trends and demographics in AA populations to describe screening outcomes in diverse population compared to the population in the NLST

Methods: The community based LC screening and navigation program of the UI Cancer Center and UI Health navigates patients from a FQHC in Chicago and patients from UI Health to tobacco cessation and LC screening. The screening program navigates high risk patient to screening and examines structural and social barriers that impact screening uptake and examines outcomes in high risk minority population compared to NLST cohort. Eligible screening populations from the FQHC affiliated with UI Health and the outpatient care population were screening and structural and social determinants such as a) age, b) race, c) insurance status, d) educational level, e) smoking status and f) gender were compared to that of the NLST population. The prevalence of LC and abnormal findings were compared in our diverse cohort compared to the NLST population along with an examination of impact of social determinants on LC screening outcomes.

Results: Results from the UI Health Community Based Lung Cancer Screening program demonstrated that the UI Health population which includes patients from the FQHC (Mile Square Health Center) affiliated with UI Health have higher rates of positive screens with 4 of the first 125 patients diagnosed with lung cancer. The comparison of UI Health LC screening population demonstrated the UI Health population has three times higher rate of LC screening finding at baseline screens compared to NLST population. The findings also demonstrate that UI Health population carried larger burden of current smokers and had increased determinants of health associated with poor health outcomes. The results further demonstrated that a community based lung cancer screening program built with a tobacco cessation program can increase LC screening compliance in a high risk population.

Discussion: The outcomes from our research demonstrate that a community based lung cancer screening and navigation program within an FQHC setting can increase lung cancer screening within a high risk population. The findings also suggest that the results from the NLST trial may not be generalizable to high risk racially and ethnically diverse populations. Community based screening and navigation programs may benefit from addressing social determinants such as SES, race and ethnicity, smoking status and insurance status that may impact cancer screening outcomes. The findings also suggest that additional data needs to be collected on lung cancer outcomes in racially and ethnically diverse populations to ensure current screening guidelines are able to ensure early detection and improved survival in racially and ethnically diverse populations not previously included in the pivotal screening trial.

Citation Format: Mary Pasquinelli, Karriem Watson, Scott Grumeretz, Lawrence E. Feldman, Kevin Kovitz, Arkadiusz Z. Dudek, Martha Menchaca, Matthew Koshy, Robert Winn. Lung cancer screening in high risk populations: Developing community based screening and navigation program. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C89.