Dr Melinda Aldrich on Disparities and the Importance of Screening in Lung Cancer

Melinda Aldrich, PhD, MHE, associate professor in the Vanderbilt University School of Medicine in the division of genetic medicine, discussed her ongoing research aiming to identify the drivers of disparities in lung cancer outcomes in the US.

Transcript

You are currently involved with studies regarding racial disparities in lung cancer. Can you explain some of this work?

Lung cancer is actually a really important public health problem. It is the leading cause of cancer mortality in the world, both here in the US and worldwide. One in 4 cancer deaths are due to lung cancer, so huge mortality from this particular disease, so [it's] really important that we tackle it. And there are racial disparities in the disease, particularly here in the US where we think about race. Some of the work that I do is trying to understand how those disparities play out not only in risk, but also outcomes such as survival, stage of presentation, and, really important to the landscape today with lung cancer, where we are now screening for lung cancer. It's the last major cancer that we [started to] screen for—we screen for breast, colorectal, prostate, and finally we now have a screening test for lung cancer. However, some of the work that we're doing is trying to address the disparities in lung cancer screening—not only trying to understand disparities in the the biology of the disease, but also disparities in eligibility for lung cancer screening.

Is there any specific research you're working on right now in this area?

We are, in particular, trying to develop risk models for eligibility for lung cancer screening. Historically and currently under the USPSTF, which is the United States Preventive Services Task Force, we screen based on age and smoking eligibility. We're now thinking about more comprehensive ways to assess eligibility for lung cancer screening using other variables or risk factors, such as your family history, for example—that's a really important one. So that's some of the work we're doing to try to address the disparities in eligibility.

With data showing patients of certain backgrounds are more likely to be diagnosed at later stages of cancer, how can we improve screening and diagnosis to catch these individuals at earlier stages?

Screening is great, because it's one of the ways that we can begin to shift the landscape for for lung cancer and really have improved outcomes, much better survival with screening. But a lot of patients around the country are not yet aware that we have lung cancer screening, and so raising awareness about the availability of this fairly new test we have—it has been around for 10 years, but now we need to raise awareness about the availability of lung cancer screening.

We're currently screening only about 10% to 15% of the eligible population. This is in contrast to mammography, where we're screening about 80% of the eligible population, so huge difference between those. We have a long way to go to really change outcomes for lung cancer patients, but there's a lot of promise. But we need to be able to also make sure that those that need it most are getting access to lung cancer screening and also addressing things like medical mistrust and structural racism that might also be barriers to lung cancer screening access. We have barriers potentially not only at the patient level in raising awareness, but also within our health care systems that we need to address to really bring screening to all populations.