Abstract PO-235: Changes in low-dose CT lung cancer screening patterns post-COVID-19
Authors: Hullin Katherine , Olson Jessica 
Published: January 2022

Abstract
Purpose: Nationally, only 23% of lung cancer cases are diagnosed at an early stage and on top of that Black Americans with lung cancer are 16% less likely to be diagnosed early. If everyone currently eligible were screened, close to 48,000 lives could be saved. Interestingly, pre-COVID-19 17% of the individuals getting screened for lung cancer were Black, and post-COVID-19 36% are Black. This study aims to explore potential reasons for this sudden increase in low-dose CT lung cancer screenings in Black patients by examining variables in the electronic health record and by interviewing pundits in clinical oncology practice. Methods: 416 deidentified electronic health records were collected from a data repository at the Medical College of Wisconsin. We analyzed low-dose CT screening for lung cancer among Black and white patients pre- and post-COVID-19 (4 cohorts). The post-COVID-19 cohorts looked at screening from 1/1/2020 – 7/8/2021, compared to a proportionate time frame pre-COVID-19 (1/1/2018 – 7/8/2019). Because of low numbers of other racial/ethnic backgrounds (Asian, Hispanic, Pacific Islander, etc.), only Black and white patients were examined in this study. Variables examined include insurance status, marital status, age, COVID-19 testing or diagnosis, gender, employment status, comorbidities (cardiovascular disease, chronic obstructive pulmonary disease, diabetes and hypertension), and lung cancer diagnosis. Results: Employment status, lung cancer diagnosis, and gender were all significantly different between Black and white cohorts pre-COVID-19. Post-COVID-19, similar differences are seen in employment status, while patterns in lung cancer diagnosis, gender, and insurance status are contradictory. Black patients pre-COVID-19 had a higher incidence of being men and a lower incidence of lung cancer diagnosis. On the contrary, post-COVID-19 Black patients have a higher incidence of being women and lung cancer diagnosis, and additionally a higher incidence of Medicare use. Despite the drastic differences in healthcare before and after COVID-19, COVID-19 testing and diagnosis did not appear to be linked to increased lung cancer screenings for Black patients. However, in conversations with thoracic surgeons and community health workers, we learned of significant screening efforts within Black populations due to grants funded during the COVID-19 pandemic. Conclusions: In this study, insurance status was the strongest difference between the pre- and post-COVID-19 Black cohorts. In a conversation with thoracic surgeons, we learned that a major initiative was launched post-COVID-19 that increased insurance access for Black populations. Increasing access to healthcare appears to be a promising first step in eradicating lung cancer disparities in Black populations. So, this research could serve as a guidepost to provide policymakers, researchers and healthcare providers, as well as patients and families, with data that pinpoints where future resources should be aimed in the effort to end lung cancer and its corresponding health disparities.
Citation Format: Katherine Hullin, Jessica Olson. Changes in low-dose CT lung cancer screening patterns post-COVID-19 [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-235.