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  • These substantial and significant differences in eligibility

    2019-08-11

    These substantial and significant differences in eligibility based on sexual identity SC 560 with the relatively minimal differences in receiving a CT scan for lung cancer during the past year. Our findings suggest a potential need to increase LDCT screening utilization among all those eligible, regardless of sexual identity. This low level of utilization of CT scans to screen for lung cancer is particularly troubling in the context of a substantial sexual-orientation-related disparity in eligibility and indicates LDCT screening may be disproportionately benefitting heterosexual adults. Indeed, prior research shows that healthcare interventions can exacerbate inequalities [10], making it critical that health policymakers be aware of the discrepancy between rates of LDCT eligibility and the use of CT scans for lung cancer to more effectively detect and manage lung cancer among sexual minorities. Several limitations of the current study should be noted. First, data were cross-sectional and thus causality cannot be determined. Second, the question about CT scans for lung cancer were based on the past-year and do not take into consideration prior-to-past year screening. Moreover, the survey questions do not specifically address whether the CT scan was performed as part of a lung cancer screening program; the scans could have been performed for diagnostic purposes under non-low dose protocols. Third, sample sizes were relatively small in analyses stratified by sex; several differences of considerable magnitude in rates of LDCT eligibility and CT scans for lung cancer lacked power to reach statistical significance. Fourth, information about sexual identity was missing for 15.5% of respondents, which is substantially higher than in prior studies using BRFSS data from different states [11]. Finally, given that the questions used for this study were optional and only five states included them, the results are not representative of the entire U.S. Despite these limitations, our results can help inform health services research and health care providers about the potential risks for lung cancer among older sexual minorities. More research is needed to identify potential barriers to receiving LDCT screens within this population. In conclusion, interventions are needed to increase awareness and utilization of LDCT screening among high-risk smokers, particularly sexual minority smokers. Further research is needed to better understand reasons for the low levels of utilization of CT scans for lung cancer particularly among sexual minorities who tend to have a higher rate of eligibility. Insurance coverage and affordability may partly explain this discrepancy. In particular, sexual minority respondents are more likely to report challenges affording care than their heterosexual counterparts [12] and have been shown to have less access to health care due to sexual orientation discrimination [[13], [14], [15]]. Accordingly, greater efforts are needed to increase access to health care services that promote early detection and treatment of lung cancer in this vulnerable population.
    Author contributions
    Conflict of interest statement
    Acknowledgments This work was supported by research grants from the National Institutes of Health [R01CA203809, R01CA212517, R01DA044157, and R01DA043696]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Cancer Institute. SC 560 The sponsors had no additional role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. There was no editorial direction or censorship from the sponsors.
    Introduction Australia has three organized population-based screening programs directed at cancers of the breast, cervix and bowel [1]. The economic case for screening includes comparisons between effectiveness, absolute cost and cost-effectiveness of screening and alternative uses of screening resources [2]. Screening target age ranges were decided largely through these kinds of comparative analyses and considering potential harms and benefits [3].