Awareness and Cost Hinder Lung Cancer Screening for Asian Americans

Lung cancer screening continues to prove difficult to achieve among Asian American individuals, despite this cancer being the top cause of cancer-related deaths among this population and cancer overall the leading cause of death, according to research presented at the recent American Thoracic Society 2024 international conference.¹

The primary reasons for lack of screening are lack of awareness and concern and cost.

Lung cancer is the leading cause of cancer death among Asian Americans/Native Hawaiians/Pacific Islanders, according to the American Lung Association.² In addition, research has shown that lung cancer incidence is increasing among Asian American, female, nonsmokers compared with all other populations.³

Electronic health record data from Kaiser Permanente Northern California were used for this analysis. Eligibility criteria were being of any Asian ethnicity and not yet screened for lung cancer. Of the 1004 randomly samples patients initially included, the most commonly spoken language was English (n = 504; 50.2%), followed by Chinese (n = 300; 29.8%) and Vietnamese (n = 200; 19.9%). All were administered a survey either electronically or through the mail that was in English, Chinese, or Vietnamese. The survey asked about demographics, smoking history (to confirm screening eligibility via US Preventive Services Task Force recommendations), and attitudes toward and perceived barriers to lung cancer screening.

In this survey, the top 3 reasons for not being screened for lung cancer were lack of information on the test, cost, and not having symptoms | Image Credit: Irin-stock.adobe.com

Response options ranged from no answer to strongly agree, and some of the statements they responded to were, “I don’t know enough about the test,” “I would rather not know if I have any lung problems,” "I worry about being blamed for having smoked,” “Transportation would be a problem,” and “I do not trust the healthcare system.”

There was a 15% response rate to the survey, among whom 102 were eligible for screening. Most surveys were completed in English (n = 44), followed by Chinese (n = 34) and Vietnamese (n = 24). The typical patient age was 65 years and a 40 pack-year smoking history. At the time of the survey, close to half (48%) were currently smoking, most self-identified as Chinese (42%) or Vietnamese (24%), 74% were male patients, less than half (49%) were a high school graduate, and 30% had an annual household income below $40,000.

Overall, just 19% reported awareness of lung cancer screening prior to receiving the current survey. Among the survey population, the top reasons for delaying a lung cancer screening were as follows:

• 40.2% reported now knowing enough about the test
• 36.3% reported cost to be an issue
• 31.4% reported lacking lung problems or symptoms
• 30.4% reported worry over finding something wrong
• 20.5% didn’t have a family history
• 18.7% do not have the time
• 18.6% would rather not know if something was wrong
• 15.7% did not think it was worth the effort
• 14.7% did not want to be blamed for being a smoker
• 14.7% thought they were too old

Issues asked about in the survey that were shown to not be principal screening barriers were lack of transportation, lack of trust in the health care system, and a previous bad experience with a health care provider; each were reported by less than 10% as a reason for not being screened for lung cancer.

The study investigators noted that findings were consistent between those who spoke English and those who did not speak English.

They also highlight the great need for stepped-up efforts to increase awareness about the benefits of lung cancer screening, as well as education in the space.

Reference

1. Caruso C, Kim RY, Zeb S, at al. Perceived barriers to lung cancer screening in Asian Americans. Presented at: American Thoracic Society 2024 international conference; May 17-22, 2024; San Diego, CA. https://www.abstractsonline.com/pp8/#!/11007/presentation/9849

2. Asian Americans and lung health. American Lung Association. Accessed May 31, 2024. https://www.lung.org/about-us/diversity-inclusion/asian-pacific-heritage-lung-health

3. Petrullo J. Digging into the increasing lung cancer rate for female, Asian, never smokers: Dr Jeffrey Velotta. AJMC^®. October 9, 2023. Accessed May 31, 2024. https://www.ajmc.com/view/digging-into-the-increasing-lung-cancer-rate-for-female-asian-never-smokers-dr-jeffrey-velotta