Addressing lung cancer screening gaps in refugee populations: Insights from a retrospective cohort in upstate New York.

Abstract

e22532 Background: Lung cancer screening (LCS) prevalence is low (16.4% in 2022) in eligible patients nationally and may be lower in high-risk groups. Refugees from countries with high smoking prevalence have a compounded risk of lung cancer. The WHO South-East Asian Region has the highest percentage of tobacco use (26.5%). The highest incidence of lung cancer is found in the Eastern Asian region in males. Upstate NY houses 91% of NYS refugees, 75% of whom are from Congo, Syria, Afghanistan, and Burma, yet their cancer prevention needs remain poorly understood. This pilot study aims to assess the characteristics of refugees eligible for screening, proportions referred, completion of imaging, and potential barriers to screening. Methods: A retrospective cohort study was conducted by selecting refugee patients seen at a refugee health center in upstate NY between 1/1/2014 - 12/31/2024 who met the criteria for lung cancer screening based on the 2022 Centers for Medicare & Medicaid Services criteria (CMS). Demographics, pack-years (PY), referral for screening, and completion of chest CT were collected using Epic’s SlicerDicer and chart review. Since data on race/ethnicity/source country was deficient, preferred language in Epic was used as a proxy for region of origin. Data lacking calculable PY was excluded from eligibility. Data was analyzed using descriptive statistics. Results: A cohort of 442 current 33.48% (148) or former 66.52% (294) smokers aged 50–77 was identified. Only 49.55% (219) had complete documentation of PY, 22% (49) of which met eligibility criteria for LCS. The eligible group had a median age of 64.0 (56.0–71.0) years, was mostly male 83.67% (41), and a median of 25.15 (22.5–35.0) PY. Preferred languages were Nepali 38.8% (19), Arabic 16.3% (8), Spanish 16.3% (8), Karen/Karenni/Pwo Karen/Burmese 14% (7), Dari 4.1% (2), Kinyarwanda 4.1% (2), Somali 4.1% (2), and Hindi 2.0% (1). 46% (23) were referred for LCS. 14% (7) of those eligible were not referred due to utilization of a LCS template based on old CMS criteria. 56% (13) of those referred completed a chest CT. Conclusions: LCS in this center was higher than the national prevalence. Despite increased efforts, over half of smokers aged 50–77 lacked complete PY documentation, likely underestimating eligibility and reducing referrals. This arises when discrete fields for packs or years are left incomplete, limiting the ability to identify eligibility for LCS or targeted community outreach. Adding a LCS eligibility question to the intake form and adhering to standardized templates is a potential solution. This intervention can be applied and translated to diverse populations across the nation. Based on language, eligible patients may be from regions with high tobacco use, underscoring the importance of culturally and linguistically tailored efforts to address barriers to care.