Northern Neck Times

Racial disparities in lung cancer start with research

In 2018, Herbert Buff, a regular visitor to the Good Samaritan Clinic in Morganton, North Carolina, casually noted that he sometimes has trouble breathing.

He is 55 years old and has been a smoker for decades. So doctors advised Buff to board a 35-foot-long bus run by the Levine Cancer Institute. The bus will run through town later in the week and offer free lung cancer screenings.

Buff found the “lung bus” concept strange, but he’s glad he jumped on it.

“I found out I might have lung cancer, but I don’t even know it,” said Buff, who was diagnosed at stage 1 by doctors at the Rolling Clinic. It could have saved my life, it could have given me a few more years.”

In this rural area of western North Carolina, hospitals and clinics are difficult and often inaccessible for some people, so lung baths are a big draw, according to screening program coordinator Darcy Doge. .

“Our team makes people feel welcome,” she said. “We can see up to 30 of her patients a day, referred by her primary care physicians and pulmonologists, but we also accommodate walk-ups.”

lung cancer deadliest of all cancersIt grows silently and is usually not detected until it spreads to other parts of the body. becomes.

Although black smokers develop lung cancer at a younger age than white smokers, even if they smoke fewer cigarettes, the guidelines doctors use to recommend screening for their patients are: It took time to reflect on the disparity. Had Buff had the same conversation with his doctor a year ago, he wouldn’t have been eligible for the CT scan that detected a dime-sized tumor in his left lung. prize.

But screening is only part of the problem, say experts who evaluate what happens before and after checking for signs of cancer.

Researchers are concerned that the clinical studies that underpin screening recommendations do not include diverse representatives. For example, about 13% of the US population is black, but blacks make up only 4.4% of her participants. National lung screening testa large, multi-year study in the early 2000s, examined whether screening with low-dose CT scans reduces mortality from lung cancer.

Dr. Carol Mangione, chair of the U.S. Preventive Services Task Force, a panel of national experts who make recommendations on services such as screening and behavioral counseling, said that creating guidelines based on trials with very little diversity could lead to a higher risk of disease. Delayed detection can lead to high mortality, he said. , and prophylactic drugs.Its recommendations play an important role in deciding which tests and procedures health insurance company Agree to pay.

“For example, we know that black people are more likely to be diagnosed with colon cancer and die,” Mangione said. “Historically, however, black people have been poorly represented in clinical trials. There is not enough evidence to say that blacks should have a different recommendation.

When Buff was diagnosed with lung cancer, the U.S. Preventive Services Task Force recommended screening anyone over the age of 55 who had smoked 30 pack-years, or an average of one pack a day. . thirty years. Buff made the cut.

but, 2019 survey A study published in JAMA Oncology found that under these parameters, 68% of black smokers were ineligible for screening at the time of lung cancer diagnosis compared to 44% of white smokers. In 2021, the U.S. Preventive Services Task Force will lower the recommended lung cancer screening age to 50 and the pack years to 20.

of new guidelines Make more than 8 million Americans eligible for testing. But that’s not the only problem that needs to be addressed, says Gerard Silvestri, M.D., a lung cancer pulmonologist at the Medical University of South Carolina.

“It doesn’t matter if there are more African Americans who don’t have insurance, who mistrust the health care system, and who don’t have access to it, whether they qualify,” Silvestri said.

“It has the potential to exacerbate this disparity, as more whites are likely to be covered and access will likely increase.”

Silvestri co-leads a four-year, $3 million portion of the Medical College of South Carolina. fighting cancer A grant project focused on addressing lung cancer disparities. Researchers in a multicenter study involving the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill and the Massey Cancer Center at Virginia Commonwealth University said better screening rates improve outcomes in underserved communities. .

“Patients of color, especially those who are black, have less access to care, less timely follow-up when they have abnormal findings, and tend to be at later stages of diagnosis,” says Reinberger. Epidemiologist Louise Henderson, principal investigator of the Center’s study, said.

Experts say concerted community efforts are needed to address a range of health disparities that have negative consequences for communities of color. The Lung Bus Buff visited is just one example of how cancer researchers can deploy programs in rural areas. In March 2017, the Atrium Health Levine Cancer Institute in Charlotte, North Carolina, launched a cancer screening program to make screening more accessible to underserved, uninsured, or underinsured people in vulnerable communities. has started its efforts.

The buses serve 19 counties in North and South Carolina.and Analysis published in the journal The Oncologist In 2020, the Levine Cancer Institute said the project had identified 12 cancers in 550 patients, calling the results a “policy change.”

By September 2021, the researchers said Bass had identified 30 cancers in 1,200 screened patients. “Twenty-one of her cases were in a potentially curable stage,” said Dr. Derek Raghavan, director of the Levine Cancer Institute and lead author of the analysis. About 78% of those tested were from poor rural areas and 20% were black Americans, he said.

“We can overcome disparities in care if we really want to,” says Raghavan.

The Reinberger Center also partnered with federally accredited health centers in the Raleigh-Durham area to recruit community health advisors to educate patients about lung cancer risks and ease of screening. It also trained patient and financial navigators to handle the often overwhelming aftermath of diagnoses.

Recent research in JAMA Oncology and the Journal of the National Cancer Institute We found that the expansion of Medicaid under the Affordable Care Act improved overall cancer survival rates for all racial and ethnic groups and narrowed racial disparities in cancer survival rates. Of his three research facilities participating in the Lung Cancer Disparity Project, his Massey Cancer Center in Virginia is the only one to expand Medicaid in the state.

Vanessa Sheppard, the center’s associate director of community outreach engagement and health disparities, said she’s seen anecdotal evidence that increasing health insurance coverage improves cancer screening rates. .

Despite this, awareness of screening remains low in the black community. Shepherd believes that it may be due to general health care providers not educating their patients about available screening tools.

Low-dose CT scans, for example, are one of the most powerful tools available to detect lung cancer early and reduce mortality. However, according to 2022 Lung Health Barometer About 70% of people don’t even know that type of screening is available, according to the American Lung Association. According to Silvestri, only a small percentage of eligible people actually get screened.

Perhaps the final hurdle is closing disparities in who receives follow-up care after screening. Research published in the journal BMC Cancer in 2020 Black patients referred to lung cancer screening programs are still less likely than white patients to be screened and have been found to be delayed in seeking follow-up care when screened.

Henderson said some patients mistakenly believe that lung cancer is incurable and simply don’t want to hear the bad news.

Sheppard says screening can be used to educate patients and build trust.

“Once we have people in the system, making sure they understand what is expected of them, that it is not a one-time thing, and that we are including them in the system of care. It’s our responsibility,” she said. “I think it helps a lot.”

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