Lung Cancer Screening Participation Among Indigenous Peoples Worldwide: A Systematic Review of Challenges and Opportunities.

issue addressedLung cancer screening (LCS) is crucial for Indigenous populations due to their higher lung cancer incidence rates and poorer outcomes. Despite efforts to establish LCS programmes, evidence on LCS cost-effectiveness, participation rates, facilitators and barriers for Indigenous peoples remains limited. This systematic review aims to address this gap by reviewing available evidence.

methodsThis systematic review conducted searches for relevant articles in PubMed, Scopus, CINAHL, Google Scholar and references/citations of included articles.

resultsFifteen out of 19 eligible studies were conducted in the USA, three in New Zealand and one in Canada, with 23 715 Indigenous participants in the 15 quantitative studies. New Zealand studies found that LCS is cost-effective for Māori, while the participation rate for American Indian/Alaska Natives (4.7%) was lower than for White Americans (21.7%). Facilitators included positive views of LCS, trust in Indigenous-centred care/providers, trusted invitations, family and community support, transportation or flexible scheduling, culturally competent navigators and detailed health education. Barriers included limited knowledge about LCS/eligibility criteria, fear of the screening process or cancer diagnosis, mistrust or negative experiences in healthcare, cost and time constraints, limited transportation/resources and non-inclusive eligibility criteria.

conclusionsFurther research is needed to understand the LCS among Indigenous peoples. Enhancing LCS participation requires leveraging positive experiences and addressing barriers with culturally tailored education and strategic resource allocation. SO WHAT?: For Australia and similar countries preparing for LCSPs, global evidence highlights the need for adequate resources, integration of Indigenous cultural practices and active involvement of Indigenous communities in programme planning.