Lahey Hospital and Medical Center, Burlington, Massachusetts.
J Am Coll Radiol. 2019 Apr;16(4 Pt B):601-606. doi: 10.1016/j.jacr.2018.12.028.
Lung cancer screening is just starting to be implemented across the United States. Challenges to screening include access to care, awareness of the option for screening, stigma and implicit bias that are due to stigmatization of smoking, stigma of race, nihilism with lung cancer diagnosis viewed as a "death sentence," shared decision making, and underestimation of lung cancer risk. African Americans (AA) have the highest lung cancer mortality rate in the United States despite similar smoking rates as whites. AAs are diagnosed at a later stage, and there is a greater likelihood they will refuse treatment options when diagnosed. Additionally, fewer AAs were found to meet lung cancer screening eligibility criteria compared with whites because of lower tobacco exposure and younger age at time of diagnosis. Outreach and access for lung cancer screening in the AA community and other subpopulations at risk are critical to avoid further increasing disparities in lung cancer morbidity and mortality as lung cancer screening is implemented across the United States. The path forward requires implementing outreach programs and providing lung cancer screening in underserved communities at high risk for lung cancer; consideration of using National Comprehensive Cancer Network guidelines for screening selection criteria, including risk model screening selection; and developing interventions to address stigma, clinician implicit bias, and nihilism.
肺癌筛查在美国才刚刚开始实施。筛查面临的挑战包括获得医疗服务的机会、对筛查选择的认识、由于吸烟而产生的污名化和隐性偏见、种族污名化、对肺癌诊断的虚无主义（被视为“死刑”）、共同决策，以及对肺癌风险的低估。尽管非裔美国人（AA）的吸烟率与白人相似，但他们的肺癌死亡率却是美国最高的。AA 被诊断为晚期，而且在被诊断后更有可能拒绝治疗选择。此外，与白人相比，由于吸烟暴露量较低和诊断时年龄较小，较少的 AA 符合肺癌筛查的资格标准。在 AA 社区和其他高危亚人群中开展肺癌筛查的宣传和获取工作至关重要，以避免随着肺癌筛查在美国的实施，肺癌发病率和死亡率的差异进一步扩大。前进的道路需要实施宣传计划，并在癌症高发的服务不足的社区提供肺癌筛查；考虑使用国家综合癌症网络的筛查选择标准，包括风险模型筛查选择；并制定干预措施来解决污名化、临床医生隐性偏见和虚无主义问题。
