Abstract
Disease stage at the time of diagnosis is the most important determinant of prognosis for lung cancer. Despite demonstrated effectiveness of lung cancer screening (LCS) in reducing lung cancer mortality, early detection continues to elude populations with the highest risk for lung cancer death. Consistent with the national rate, current screening rate in Alabama is dismal at 4.2%. While public awareness of LCS may be a likely cause, there are no studies that have thoroughly evaluated current knowledge of LCS within the Deep South. Therefore, we measured LCS knowledge before and after receiving education delivered by community health advisors (CHAs) among high-risk individuals living in medically underserved communities of Alabama and to determine impact of psychological, demographic, health status, and cognitive factors on rate of lung cancer screening participation. Participants were recruited from one urban county and six rural Black Belt counties (characterized by poverty, rurality, unemployment, low educational attainment, and disproportionate lack of access to health services). One hundred individuals (i) aged between 55 and 80 years; (ii) currently smoke or have quit within the past 15 years; and (iii) have at least a total of 30-pack-year smoking history were recruited. Knowledge scores to assess lung cancer knowledge were calculated. Paired t-test was used to assess pre- and post-knowledge score improvement. Screening for lung cancer was modeled as a function of predisposed factors (age, gender, insurance, education, fatalism, smoking status, and history of family lung cancer). Average age was 62.94 (SD = 6.28), mostly female (54%); mostly current smokers (53%). Most participants (80.85%) reported no family history of cancer. Fatalism was low, with a majority of the participants disagreeing that a cancer diagnosis is pre-destined (67.7%) and that there are no treatments for lung cancer (88.66%). Overall, lung cancer knowledge increased significantly from baseline of 4.64 (SD = 2.37) to 7.61 (SD = 2.26). Of the 100 participants, 23 underwent screening due to lack of access to primary care providers and reluctance of PCPs to provide referral to LCS. Sixty-five percent of those who were screened reported no family history of lung cancer. Regression analysis revealed no significant association between risk factors and the decision to get screened by participants. Our study demonstrates that while CHA delivered education initiatives increases lung cancer screening knowledge, there are significant structural barriers that prohibit effective utilization of LCS which needs to be addressed.
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Appendices
Appendix I
LCS12 Participant #: Participant initials:
Lung Cancer Screening in the Deep South
12-item lung cancer screening knowledge measure.
Instructions: Please check mark the most appropriate answer
1. What percentage of lung cancer deaths are caused by smoking?
□ About 70%
□ About 85% *
□ Nearly 100%
□ I don’t know
2. Where does lung cancer rank as a cause of cancer death in the US?
□ #1 cause of cancer deaths *
□ #2 cause of cancer deaths
□ #3 cause of cancer deaths
□ I don’t know
3. When should someone stop being screened for lung cancer? (Check all that apply)
□ You quit smoking more than 15 years ago*
□ Your last CT scans shows you do not have cancer
□ You have other health problems that may shorten your life
□ You are not able or willing to be treated for lung cancer
□ I don’t know
4. How many people with an abnormal CT scan will have lung cancer?
□ Most will have lung cancer
□ About half will have lung cancer
□ Most will not have lung cancer*
□ I don’t know
5. Can a CT scan suggest that you have lung cancer when you do not?
□ Yes*
□ No
□ I don’t know
6. Can a CT scan miss a tumor in your lungs?
□ Yes*
□ No
□ I don’t know
7. Will all tumors found in the lungs grow to be life threatening?
□ Yes
□ No *
□ I don’t know
8. Without screening, is lung cancer often found at a later stage when cure is less likely?
□ Yes *
□ No
□ I don’t know
9. How much does screening for lung cancer with a CT scan lower your chances of dying from lung cancer?
□ About 95%
□ About 50%
□ About 20% *
□ I don’t know
10. Can a CT scan find lung disease that is not cancer?
□ Yes *
□ No
□ I don’t know
11. Can a CT scan find heart disease?
□ Yes *
□ No
□ I don’t know
12. Is radiation exposure one of the harms of lung cancer screening?
□ Yes *
□ No
□ I don’t know
Appendix II
CFS Participant #: Participant initials:
Lung Cancer Screening in the Deep South
CANCER FATALISM SCALE
Please choose and check mark your response to the following statements by indicating whether you Strongly Agree; Agree; Neither Agree nor Disagree (Neutral); Disagree; or Strongly Disagree.
Strongly Agree | Agree | Neutral | Disagree | Strongly Disagree | |
|---|---|---|---|---|---|
‘If someone is meant to get cancer, they will get it no matter what they do’ | |||||
If someone has cancer, it is already too late to get treated’ |
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Niranjan, S.J., Opoku-Agyeman, W., Hardy, C.M. et al. Using Community Health Advisors to Increase Lung Cancer Screening Awareness in the Black Belt: a Pilot Study. J Canc Educ 38, 1286–1295 (2023). https://doi.org/10.1007/s13187-022-02261-w
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DOI: https://doi.org/10.1007/s13187-022-02261-w