Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System

Seth J Tivakaran; Julia L Raghu; Jeff C K Leung; King Sum Tong; Nicholas L Panyanouvong; Carmen Javier; Sheng-Fang Jiang; Lester Andrew V Uy; Armaan Jamal; Malathi Srinivasan; Nitya Rajeshuni; Gloria S Kim; Robert J Huang; Latha Palaniappan; Jeffrey B Velotta

doi:10.1177/00031348251353073

Lung Cancer Screening Disparities in Asian American Subgroups in a Large Integrated Health System

Am Surg. 2025 Jun 24:31348251353073. doi: 10.1177/00031348251353073. Online ahead of print.

Authors

Seth J Tivakaran^{1

2}, Julia L Raghu^{1

2}, Jeff C K Leung^{1

2}, King Sum Tong^{1

2}, Nicholas L Panyanouvong^{1

2}, Carmen Javier³, Sheng-Fang Jiang⁴, Lester Andrew V Uy^{1

2}, Armaan Jamal^{1

2}, Malathi Srinivasan^{1

2}, Nitya Rajeshuni^{1

2}, Gloria S Kim^{1

2}, Robert J Huang^{1

2}, Latha Palaniappan^{1

2}, Jeffrey B Velotta^{4

5

6

7}

Affiliations

¹ Stanford University School of Medicine, Palo Alto, CA, USA.
² Department of Medicine, Stanford Center for Asian Health Research and Education, Palo Alto, CA, USA.
³ Kaiser Permanente Northern California San Francisco, San Francisco, CA, USA.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
⁵ Department of Surgery, UCSF School of Medicine, San Francisco, CA, USA.
⁶ Department of Clinical Sciences, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
⁷ Kaiser Permanente Northern California Oakland, Oakland, CA, USA.

PMID: 40551614
DOI: 10.1177/00031348251353073

Abstract

BackgroundLung cancer is the leading cause of cancer-related deaths worldwide in Asian Americans (AsA), yet AsA lung cancer screening (LCS) rates are unknown. We examined LCS rates in AsA within Kaiser Permanente Northern California (KPNC), a large integrated healthcare system where LCS is a member benefit. The California LCS rate is 0.7%.MethodsThis cohort study analyzed KPNC 2015-2022 electronic health records. Lung cancer screening rates were compared among AsA subgroups, controlling for sociodemographics, considering both more restrictive 2013 (n = 2,273) and more inclusive 2021 (n = 5,823) United States Preventive Services Task Force (USPSTF) LCS guidelines, which differ by age range and years post-smoking cessation.ResultsOverall KPNC LCS rates for eligible AsA patients were 4.3% and 2.7% using USPSTF 2013 and 2021 guidelines, respectively. Lung cancer screening rates varied by AsA subgroup. Under 2021 guidelines, Chinese (4.0%) were screened more than Korean (3.57%), Southeast Asian (3.52%), Japanese (3.19%), Asian (Other) (2.28%), Pacific Islander (1.91%), and Filipino (1.55%). Under 2013 guidelines, Southeast Asian (6.54%) were screened more than Chinese (6.51%), Japanese (5.36%), Asian (Other) (3.95%), and Filipino (1.93%).DiscussionThis is the first study to demonstrate significant heterogeneity in LCS rates for disaggregated AsA subgroups. Kaiser Permanente Northern California LCS rates were 4× California rates. When payment alone is not a care barrier, systemic and culturally sensitive interventions are necessary to increase overall LCS screening rates and address population-specific disparities.

Keywords: Asian Health Disparities; Integrated Healthcare System; Lung Cancer Screening.