Racial inequalities in eligibility and access to lung cancer screening: systematic review of United States studies

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INTRODUCTION: In 2021, the United States Preventive Services Task Force introduced new guidelines aimed at reducing racial inequalities by lowering the smoking threshold and expanding age eligibility for screening. However, while some studies suggest these updates have increased eligibility and access, the impact of these changes on racial inequalities in lung cancer screening (LCS) eligibility and access has yet to be systematically reviewed. This study aims to synthesize existing evidence on racial disparities in LCS eligibility and access in the U.S. following the 2021 guideline reform. METHODS: We searched PubMed and Web of Science for studies using keywords related to race, lung cancer, and screening in the United States. The final search was conducted on July 25th, 2024. Articles were included if they quantified access or eligibility for one or more racial groups, enabling quantification of either absolute or relative inequality. Our final analytical sample included 26 articles. RESULTS: Of the 26 studies reviewed, 12 evaluated disparities in eligibility, and 17 assessed racial disparities in LCS access. All eligibility studies reported that Black Americans, Hispanics, and Asian Americans had lower eligibility rates compared to White Americans; estimated gaps between White and Black Americans ranged from 3.4 to 26.9% points and between 4.7 and 33.1 ppts between Whites and Hispanics. Gaps in access to LCS, conditional on eligibility, were narrower, ranging from 1.42 to 12.9 ppts. Higher disparities were observed on the U.S. East Coast compared to the West Coast. CONCLUSION: Despite changes to guidelines aiming to ameliorate inequalities LCS, inequalities in both eligibility and access remain pronounced, especially for Black and Hispanic Americans. Further reforms are needed to adjust for lower eligibility among groups with higher levels of LCS need. Additionally, geographic differences, such as more pronounced disparities on the East Coast, suggest that regionally tailored approaches may support efforts to advance racial equity.

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