A narrative review of the social determinants of lung cancer screening: knowledge gaps and controversies

Background and Objective: Lung cancer screening (LCS) with low-dose computed tomography (CT) is an established modality for detecting early-stage disease, with a downstream lung cancer-related mortality benefit. The Center for Medicare & Medicaid Services instituted LCS coverage in February 2015 and expanded screening eligibility in February 2022. However, disparities in LCS are multifold, expanding from minority underrepresentation in trial design to variable uptake and adherence to screening practices. These variances in cancer treatment challenge the delivery of equitable care. This review explores these disparities, exposing some knowledge gaps and controversies related to LCS practices, with the intent to influence clinical practice and health equity research initiatives. Methods: An extended review of the literature through PubMed was conducted using keywords related to LCS, social determinants, disparity, and inequity. Publications in English, published between January 1^st 2000 and May 25^th 2023, were considered. Key Content and Findings: Results from multiple clinical trials have established the benefits of LCS for high-risk individuals. Recent broadening of LCS criteria by the US Preventative Services Task Force (USPSTF) and Centers for Medicare and Medicaid Services (CMS) increases LCS eligibility especially among Black and African Americans, though cannot individually reduce health inequities. Health disparities of LCS in the research, uptake, adherence and follow-up care persist. These disparities are complex and differ among different populations and individuals. Conclusions: Provider awareness of foundational health disparities in LCS and their extension into current LCS practice, additional population-specific research and patient-centered solutions for LCS implementation are needed to guide a sustainable, equitable future for LCS.