Lung Cancer Screening Access and Cancer Stage at Diagnosis Among American Indian and White Patients.

PURPOSE: Given persistently low rates of lung cancer screening among eligible individuals, we examined racial and geographic differences in proximity to low-dose computed tomography (LDCT) screening facilities among American Indians and Alaska Natives (AIAN) and White adults in North Carolina.

METHODS

We used cancer registry data linked with health insurance claims (2016-2020) to examine a cohort of 18,154 AIAN and NHW lung cancer patients. We calculated straight-line distances between patient's residential ZIP code and nearest LDCT facility available in the year prior to diagnosis, (within ZIP code, 1-10 miles, or ≥10 miles). Logistic regression models assessed associations between distance and stage at diagnosis (localized vs. non-localized and distant vs. non-distant), adjusting for race, age at diagnosis, and health insurance status.

FINDINGS: AIAN were more likely than NHW patients to live ≥10 miles from an LDCT facility (36% vs. 17%) and less often diagnosed at a localized stage (19% vs. 26%). Patients living ≥ 10 miles away had lower odds of localized stage diagnosis (adjusted OR = 0.89; 95% CI: 0.82-0.98) compared to those with access within their residential ZIP code.

CONCLUSIONS

Greater distance to LDCT facilities was associated with reduced odds of early-stage diagnosis. Strategies such as mobile screening units and culturally tailored outreach may improve access and outcomes in underserved AIAN communities.