Lung cancer screening disparities among screening-eligible older Black adults with 20 + years of tobacco use: Quantitative findings from a mixed-methods, quasi case-control study.

backgroundLung cancer is the leading cause of cancer death in the United States and disproportionately affects Black adults. Lung cancer screening (LCS) remains narrowly focused on cigarette smoking, often excluding other tobacco use, and low provider referral rates continue to limit screening uptake. Addressing these gaps is critical to advancing screening equity.

methodsWe surveyed 100 Black adults (aged 50 + years) with a 20 + year history of tobacco use who either currently used or had quit within the past 15 years. The survey assessed tobacco use characteristics, cessation intentions, tobacco product harm perceptions, LCS-related quit motivations, and LCS knowledge and beliefs. We compared characteristics, beliefs, and experiences by LCS status (56% screened) using a quasi case-control approach.

resultsLCS uptake varied by insurance status (p = 0.03), tobacco risk perceptions (p = 0.037), past-year quit attempts (p = 0.005), and lung cancer beliefs, including early detection knowledge (p < 0.001). Screening experiences were associated with health care discrimination and LCS-related risk perceptions. Among adults reporting past-year use of combustible tobacco products other than cigarettes, unscreened adults were more likely than screened adults to report current use (22.7% vs. 5.4%; p = 0.01). Participants most identified social media (48.0%), followed by magazines/newspapers (31.0%) and local news (29.0%), as trusted sources of information on early lung cancer detection.

conclusionExpanding LCS eligibility to include non-cigarette combustible tobacco use-while addressing structural barriers, provider recommendations, gaps in screening knowledge, risk perception, and culturally responsive communication-are essential for improving the reach, implementation, and equity of LCS in Black communities.