Access to Lung Cancer Screening Among American Indians and Alaska Natives: A Qualitative Study

Welch AC, London SM, Wilshire CL, Gilbert CR, Buchwald D, Ferguson G, Allick C, Gorden JA.
Access to Lung Cancer Screening Among American Indians and Alaska Natives: A Qualitative Study
Chest. 2023 Oct 26:S0012-3692(23)05670-2. doi: 10.1016/j.chest.2023.10.025. Epub ahead of print. PMID: 37898186.

Background: Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives. American Indians and Alaska Native people use commercial tobacco products at much higher rates compared to all other race and ethnicities. Moreover, they have lower adherence to cancer screening guidelines.

Research question: How do American Indian and Alaska Native adults perceive and utilize lung cancer screening?

Study design and methods: We conducted, recorded, and transcribed three focus groups with American Indians and Alaska Native adults. Participants were recruited through convenience sampling at a national health conference. Transcripts were analyzed by inductive coding.

Results: Participants (N=58) of 28 tribes included tribal Elders, tribal leaders, and non-Native volunteers who worked with tribal communities. Limited community awareness of lung cancer screening, barriers to lung cancer screening at healthcare facilities, and health information-seeking behaviors emerged as key themes in discussions. Screening knowledge was limited except among people with direct experiences of lung cancer. Cancer risk factors such as multi-generational smoking were considered important priorities to address in communities. Limited educational and diagnostic resources are significant barriers to lung cancer screening uptake in addition to limited discussions with health care providers about their cancer risk.

Interpretation: Limited access to and awareness of lung cancer screening must be addressed. American Indians and Alaska Native adults utilize several health information sources unique to tribal communities and should be leveraged in designing screening programs. Equitable partnerships between clinicians and tribes are essential in improving knowledge and utilization of lung cancer screening.