Today on Screen the Lungs!, we will brainstorm some of the policy approaches that cancer care and health equity advocates can adopt to bolster high-level federal support of lung cancer screening programs.
We have previously established that smoking and tobacco use behaviors are most prevalent among Americans of low socioeconomic status. Given the strongly determinant link between smoking and lung cancer, one could reasonably expect that ensuring access to Lung Cancer Screening (LCS) for this population would actualize the greatest patient benefit from preventive screening.
Yet, this obvious need is left overwhelmingly unaddressed. Over half of United States Preventive Services Task Force (USPSTF) eligible smokers have been found to be either uninsured or underinsured with Medicaid programs. Medicaid – one of the only healthcare programs not required to cover LCS – is determined at the state level, and wide variations in coverage, eligibility, and copayments have been demonstrated across states.
Moreover, racial and ethnic minorities are even less likely to be fully insured, with such groups seeing significant drops in screening for lung cancer when the Low-Dose CT (LDCT) costs were expected to come out of their own pockets.
This information clearly demonstrates that some of the most vulnerable populations at risk for lung cancer have been abandoned: left without equitable access to preventive LCS services, facing disproportionate financial burden, and augmenting the existing health disparities seen in marginalized groups of Americans.
Given that Medicaid beneficiaries – a group represented by a large proportion of minority and disadvantaged populations – are at a disproportionately high risk for lung cancer development, it is unacceptable that almost a quarter of states do not include LDCT lung cancer screening as a reimbursable service in Medicaid fee-for-service plans.
Especially considering that states with Medicaid expansion have seen trends towards earlier and more treatable cancer diagnoses, it must be demanded of all state governments that LCS be fully covered by Medicaid in order to promote equitable access to preventive lung cancer care for our most vulnerable populations. Advocacy groups, health providers, and institutions should continue to lobby for these reforms at the state and national levels.
Previous federal legislation designed to ameliorate disparities in other forms of cancer lends valuable insight into policy approaches that should be implemented to bolster preventive lung cancer care.
One outstanding example is the 1990 Congressional Breast and Cervical Cancer Prevention Act, which established the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
Since 1990, the NBCCEDP has provided quality screening and early diagnostic services to millions of low-income and uninsured women in all 50 states, the District of Columbia, and 19 territories and tribal organizations. Numerous evidence-based frameworks detailing program management, clinical service guidelines, and systematic data collection and tracking exemplify some of the strong work that the NBCCEDP has done to support screening nationwide, which have since been supplemented by funding from the 2000 National Breast and Cervical Cancer Prevention and Treatment Act.
The NBCCEDP has also successfully nurtured a number of partnerships with organizations ranging from community-based groups and local government agencies to broad health care systems and national organizations such as the American Cancer Society. This growing partner network continues to expand the NBCCEDP’s reach and scope throughout communities in need through shared resources, time, and expertise.
The National Mammography Quality Assurance Advisory Committee (NMQAAC), established in 1992 by the Mammography Standards Act, complements the screening care provided by the NBCCEDP by imposing regulations on accredited screening facilities across the country, ensuring quality standards, program compliance, reliable oversight, sufficient physician availability, and proper investigation of patient complaints.
The success of the NBCCEDP and NMQAAC demonstrate the importance of establishing high level federal support to enable the logistical, strategic, and financial support necessary to ensure access to high-quality screening at all levels of cancer care, for all cancer patients — particularly for marginalized and traditionally underserved Americans.
Thus, legislation and national support for lung cancer screening initiatives that pursue similar strategies as the NBCCEDP and NMQAAC must be a prioritized item of advocacy groups, cancer organizations, healthcare providers, and patient communities.