Doris Duke Clinical Research Fellows, UMDNJ-Robert Wood Johnson Medical School, New York, NY 10029, USA.
Lung Cancer. 2012 Sep;77(3):526-31. doi: 10.1016/j.lungcan.2012.05.095. Epub 2012 Jun 6.
The National Lung Screening Trial (NLST) recently reported that annual computed tomography (CT) screening is associated with decreased lung cancer mortality in high-risk smokers. Beliefs about lung cancer and screening, particularly across race and ethnicity, and their influence on CT screening utilization are largely unexamined. Our study recruited asymptomatic, high-risk smokers, 55-74 years of age from primary care clinics in an academic urban hospital. Guided by the self-regulation theory, we evaluated cognitive and affective beliefs about lung cancer. Intention to screen for lung cancer with a CT scan was assessed by self-report. We used univariate and logistic regression analyses to compare beliefs about screening and intention to screen among minority (Blacks and Hispanics) and non-minority participants. Overall, we enrolled 108 participants, of which 40% were Black and 34% were Hispanic; the mean age was 62.3 years, and median pack-years of smoking was 26. We found that intention to screen was similar among minorities and non-minorities (p=0.19); however, Hispanics were less likely to report intention to screen if they had to pay for the test (p=0.02). Fatalistic beliefs, fear of radiation exposure, and anxiety related to CT scans were significantly associated with decreased intention to screen (p<0.05). Several differences were observed in minority versus non-minority participants' beliefs toward lung cancer and screening. In conclusion, we found that concerns about cost, which were particularly prominent among Hispanics, as well as fatalism and radiation exposure fears may constitute barriers to lung cancer screening. Lung cancer screening programs should address these factors to ensure broad participation, particularly among minorities.
国家肺癌筛查试验（NLST）最近报告称，每年进行计算机断层扫描（CT）筛查可降低高危吸烟者的肺癌死亡率。人们对肺癌和筛查的看法，特别是在种族和民族之间的看法，以及它们对 CT 筛查利用的影响，在很大程度上尚未得到研究。我们的研究招募了来自学术城市医院初级保健诊所的无症状、高危吸烟的 55-74 岁人群。我们以自我调节理论为指导，评估了对肺癌的认知和情感信念。通过自我报告评估了用 CT 扫描筛查肺癌的意向。我们使用单变量和逻辑回归分析比较了少数民族（黑人和西班牙裔）和非少数民族参与者的筛查信念和筛查意向。总体而言，我们共招募了 108 名参与者，其中 40%是黑人，34%是西班牙裔；平均年龄为 62.3 岁，平均吸烟包年数为 26。我们发现，少数民族和非少数民族的筛查意向相似（p=0.19）；然而，如果西班牙裔必须支付测试费用，他们报告筛查意向的可能性就较小（p=0.02）。宿命论信念、对辐射暴露的恐惧以及与 CT 扫描相关的焦虑与筛查意向降低显著相关（p<0.05）。在少数族裔与非少数族裔参与者对肺癌和筛查的信念方面，观察到了一些差异。总之，我们发现，对成本的担忧（尤其是在西班牙裔中更为突出），以及宿命论和辐射暴露的恐惧，可能是肺癌筛查的障碍。肺癌筛查计划应解决这些因素，以确保广泛参与，特别是在少数民族中。
