A new cohort study examined rates of lung cancer screenings across racial/ethnic groups in Hawaii, and results suggest possible disparities in completion of screenings across groups. The study findings were reported in JAMA Network Open.

Asian American, Native Hawaiian, and Pacific Islander racial/ethnic groups are often aggregated in studies on population-based health screenings. This may hide underlying disparities in uptake and diagnostic follow-up of health screenings. Therefore, researchers sought to determine the completion rates for lung cancer screening among the different racial/ethnic groups in Hawaii.

The study was performed through a health maintenance organization. People eligible for lung cancer screening were identified through electronic medical records between 2015 and 2019. Eligible persons were aged 55 to 79 years, had a smoking history of 30 pack-years, and were either current smokers or had quit in the prior 15 years. Patients also were cancer-free at the time of inclusion, with any past cancer diagnoses or treatment having been 5 or more years prior.

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Lung cancer screening completion rates were calculated based on completion of low-dose computed tomography (LDCT) orders within 91 days of orders being initiated. Rates of completion were evaluated in conjunction with data on self-reported race and ethnicity. The researchers additionally analyzed patterns of completion of follow-up visits based on Lung Imaging Reporting and Data System (Lung-RADS) staging categories.

LDCT orders existed for 1030 members of the Lung Cancer Screening program. The rate of completion, based on completing an LDCT within 91 days of order date, was 81% in this overall population.

The largest racial or ethnic population groups were non-Hispanic Whites (37.0% of the population), Native Hawaiians or part Native Hawaiians (18.1%), and Japanese (14.2%). People of Asian descent showed the highest screening completion rate, at 86%. Native Hawaiians and non-Hispanic White groups both had completion rates of 80%. Screening completion rates were 79% for Pacific Islanders, and 77% for participants classified as belonging to other racial/ethnic groups. Asian subgroups also showed some variation in lung cancer screening completion rates: people of Korean descent, 94%; people of Filipino descent, 79%.

Among patients with Lung-RADS stage 3 disease, the completion rate for 6-month follow-up surveillance LDCT was 93%. Patients with a Lung-RADS stage 4 diagnosis completed further follow-up procedures at a rate of 97%, which included biopsies, noninvasive procedures, or cytologic examinations.

“Although we observed that screening completion rates were not significantly different, there was a 14% to 15% screening completion gap between the Korean subgroup (94%) and the Filipino (79%), non-Hispanic White (80%), and Pacific Islander (79%) groups,” explained the researchers.

They recommend further studies into factors that may be associated with possible differences in lung cancer screening completion rates across groups. “Furthermore, a Nurse Navigator may play an integral role in supporting [lung cancer screening] completion and follow-up rates through strengthening the continuity of care, resulting in faster initiation of preventive care and treatment,” the researchers concluded.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Oshiro CES, Frankland TB, Mor J, et al. Lung cancer screening by race and ethnicity in an integrated health system in Hawaii. JAMA Netw Open. 2022;5(1):e2144381. doi:10.1001/jamanetworkopen.2021.44381