Heavy smokers' barriers to lung cancer screening: Results of a focus group study

Lung cancer is the leading cause of cancer-related death in the United States. In 2009, when this study was conducted, no professional organization recommended screening for lung cancer using low dose computerized tomography (LDCT) or chest X-ray. In 2011, results of the National Lung Screening Trial were published demonstrating a 20% reduction in mortality among a high risk group. The purpose of this analysis was to identify potential barriers to lung cancer screening among heavy smokers. In June 2009, a total of twelve two-hour focus groups were conducted with 105 current, heavy smokers (51 women, 54 men) in Charlotte, NC and Cincinnati, OH. “Heavy smoker” was defined as smoking the equivalent of at least 1 pack of cigarettes per day for 20 years. A semi-structured guide was used by professional moderators to facilitate discussion about lung cancer screening tests. Verbatim transcripts were produced and coded using a structured codebook. Inductive methods were used to identify key themes. We identified five barriers in addition to lack of knowledge and denial of risk for lung cancer (previously reported): cost, concerns about the screening procedure (LDCT), fatalistic beliefs, ambiguity of screening results, and distrust of the medical system. If LDCT screening for lung cancer increases, barriers to screening must be understood. Public health will have a role in educating patients about the benefits and risks of screening and promoting smoking cessation as an important component of lung cancer screening efforts. Initiatives to improve patient understanding will be needed for those at high risk.