Thousands of avoidable cancer deaths occur every year in the United States because evidence-based cancer screening interventions get "lost in translation" in the process between discovery and widespread public health and clinical practice. Lung cancer screening holds great potential to reduce cancer deaths, given the recent evidence of effectiveness of screening and the numbers of deaths attributable to lung cancer, but there has been little study of how capacity constraints in the health system might slow these efforts, as they have in screening for other cancers. To address how capacity might influence the scale-up of lung cancer screening, we propose to generate estimates of geographic variation in the number of heavy smokers from 2010-2011 population-based surveys, as well as measures of local clinical and public health system capacity derived from a diverse set of administrative and survey data from 2008-2012 on facilities, CT scanners, health workers, and public health programs. Superimposing these data maps of capacity and of the screening population, we specifically intend: 1. using multiple dimensions of lung screening capacity, to determine the proportion of the nation's heavy smokers living in areas that face capacity constraints to scaling up a program of lung cancer screening. This would reflect the geographic distribution of screening capacity and of the population of heavy smokers, as well as differences between the two. 2. To identify potential disparities in access to lung cancer screening that may emerge across racial, socioeconomic, rural/urban, and educational lines due to the geographic variation in capacity constraints. Disparities in access to screening for other cancers can be substantial, and may be intensified in lung cancer due to higher smoking rates among vulnerable subgroups.
Thousands of avoidable cancer deaths occur every year in the United States because evidence- based interventions get lost in translation in the process between discovery and widespread public health and clinical practice. This research investigates how health system capacity constraints may influence levels and disparities in access to lung cancer screening nationwide. The resulting analysis - presented in intuitive visual format using geographic information systems, as well as in statistical models - will be of great use in scaling up lung cancer screening, identifying weak links in the chain as cancer policymaker's move screening from clinical trials to routine clinical practice.
|Smieliauskas, Fabrice; MacMahon, Heber; Salgia, Ravi et al. (2014) Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening. J Med Screen 21:207-15|