Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement.
Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement.
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DOI：
10.1164/rccm.202008-3053st
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发表时间：
2020-10-01
影响因子：
24.7
通讯作者：
Aldrich MC
中科院分区：
文献类型：
--
作者：
Rivera MP;Katki HA;Tanner NT;Triplette M;Sakoda LC;Wiener RS;Cardarelli R;Carter-Harris L;Crothers K;Fathi JT;Ford ME;Smith R;Winn RA;Wisnivesky JP;Henderson LM;Aldrich MC
背景：有据可查的不同人群肺癌结果的差异。肺癌筛查 (LCS) 具有降低肺癌死亡率的潜力，但为了让所有高危人群都能实现这一益处，必须特别注意确保公平地获得这种挽救生命的预防性健康措施。目标：概述当前关于 LCS 资格标准、获取和实施方面差异的知识，并制定美国胸科学会官方声明，提出优化当前筛查指南和资源分配的策略，以实现 LCS 的公平实施和传播。方法：召集了一个由 LCS、实施科学、初级保健、肺病学、健康行为、戒烟、流行病学和差异研究方面的专业知识组成的多学科小组。参与者回顾了有关癌症筛查历史差异的现有文献以及 LCS 差异的新证据。结果：现有的 LCS 指南没有考虑吸烟行为或肺癌风险方面的种族、民族、社会经济和性别差异。包括筛查和成本在内的多重障碍进一步加剧了 LCS 实施和传播方面的不平等。结论：本声明指出了 LCS 资格标准对肺癌风险增加但不符合筛查资格标准的弱势群体的影响，以及导致 LCS 实施差异的多重障碍。描述了改善弱势群体中 LCS 的选择和传播的策略。
Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination. Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS. Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS. Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.