Prevalence and Barriers to Lung Cancer Screening in Karachi, Pakistan: A Cross-Sectional Survey of Smokers and Physicians

Lung cancer screening beliefs in Armenia

Introduction

In Armenia, an upper-middle income country, 93% of deaths are from non-communicable diseases and over half of the male population smokes. Armenia has more than double the global lung cancer incidence. Over 80% of lung cancer is diagnosed at stages III or IV. However, there is a significant mortality benefit in detecting early-stage lung cancer via screening with low-dose computed tomography.

Methods

This study employed a rigorously-translated, previously-validated survey based on the Expanded Health Belief Model to understand how Armenian male smokers' beliefs would affect lung cancer screening participation.

Results

Survey responses highlighted key health beliefs that would mediate screening participation. Most respondents felt they were at risk for lung cancer, but over 50% also believed their cancer risk was equivalent to (or less than) non-smokers' risk. Respondents also overwhelmingly agreed a scan could help detect cancer earlier, but fewer agreed early detection could reduce cancer mortality. Important barriers included absence of symptoms and costs of screening and treatment.

Discussion

Overall, the potential to reduce lung cancer-related deaths in Armenia is high, but there are a number of central health beliefs and barriers that would limit screening uptake and effectiveness. Improved health education, careful consideration of socioeconomic screening barriers, and appropriate screening recommendations may be useful in overcoming these beliefs.

Chronic Obstructive Pulmonary Disease and Lung Cancer: A Review for Clinicians

Chronic obstructive pulmonary disease (COPD) and lung cancer are common global causes of morbidity and mortality. Because both diseases share several predisposing risks, the 2 diseases may occur concurrently in susceptible individuals. The diagnosis of COPD has important implications for the diagnostic approach and treatment options if lesions concerning for lung cancer are identified during screening. Importantly, the presence of COPD has significant implications on prognosis and management of patients with lung cancer. In this monograph, we review the mechanistic linkage between lung cancer and COPD, the impact of lung cancer screening on patients at risk, and the implications of the presence of COPD on the approach to the diagnosis and treatment of lung cancer. This manuscript succinctly reviews the epidemiology and common pathogenetic factors for the concurrence of COPD and lung cancer. Importantly for the clinician, it summarizes the indications, benefits, and complications of lung cancer screening in patients with COPD, and the assessment of risk factors for patients with COPD undergoing consideration of various treatment options for lung cancer.

Perceptions of and Barriers to Lung Cancer Screening Among Physicians in Puerto Rico: A Qualitative Study

Low-dose computed tomography (LDCT), an accepted U.S. screening tool for early lung cancer detection, is not widely-used in Puerto Rico. We investigated knowledge and attitudes about LDCT in focus groups of primary care physicians (PCP) and individuals at high risk for lung cancer (HRI) in Puerto Rico. Transcribed/translated audio-recorded discussions were analyzed with the constant comparison method. Both groups had limited knowledge about LDCT and concerns regarding insurance coverage. Most HRIs had never had a provider recommend LDCT and believed that having symptoms was necessary to obtain LDCT screening. Perceived barriers included fears about results and the procedure; a perceived benefit was having early detection and possibly being cured. Few PCPs had ever recommended LDCT to a patient, with those who had basing their decision on symptoms/smoking history but having challenges with insurance. More education on LDCT is needed among HRIs, and U.S. Preventive Services Task Force guidelines should be widely distributed to encourage physician recommendations.

The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

Lung cancer accounts for an alarming human and economic burden in low- and middle-income countries (LMICs). Recent landmark trials from high-income countries (HICs) by demonstrating that low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality have engendered enthusiasm for this approach. Here we examine the effectiveness and affordability of LDCT screening from the viewpoint of LMICs. We consider resource-restricted perspectives and discuss implementation challenges and strategies to enhance the feasibility and cost-effectiveness of LDCT screening in LMICs.