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Poorer patients with lung cancer are less likely to be offered surgery or chemotherapy, at the same stage, in systems that are free at the point of use. That is a fixable problem in how care is delivered, not a fact about the disease.
Forrest's meta-analysis of 23 studies found that lower socioeconomic position was associated with a reduced likelihood of receiving any lung cancer treatment (odds ratio 0.79), of surgery and of chemotherapy, and that the gap was not explained by stage at presentation or by which health system the patient was in. The authors named it an intervention-generated inequality: produced by how care is organised, not by the disease.
Lung cancer is the cancer where this matters most, because incidence itself follows the same gradient, so the disadvantage compounds. The idea is to treat the gradient as an operational defect with named causes (distance to a thoracic surgical centre, transport, time off work, comorbidity assessment thresholds, referral behaviour, and whether the patient is offered a treatment at all) and to measure the closing of it as an outcome in its own right. UK and NHS specifics (Targeted Lung Health Check coverage and uptake, NICE positions and Cancer Drugs Fund status, molecular testing turnaround, thoracic surgery and radiotherapy capacity, audit indicators and trial access) are on the UK and NHS page for lung cancer and are not restated here.
The document that defines who is offered a scan in the United States, and therefore the document any argument about the screening eligibility gap has to engage with. Eligibility is still defined by pack-years and years since quitting rather than by an individual risk estimate.
The clearest published demonstration that a screening eligibility rule can be accurate on average and systematically wrong for a group. It is the empirical core of the argument for replacing pack-year thresholds with individual risk models.
The deprivation gradient in lung cancer is not only about who gets the disease. Among people who already have it, and at the same stage, poorer patients are less likely to be offered the treatment that works.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Not enough oncologists, nurses, pathologists, physicists and the tag lung-evidence.
Shares Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Trials do not represent the people who get cancer and the tag lung-evidence.
Shares Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Trials do not represent the people who get cancer, Lung cancer (all types) and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Weak real-world evidence and registries, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares Most of the world has almost no cancer care, Lung cancer (all types), Small-cell lung cancer, Non-small-cell lung cancer and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Fragmented care and guideline gaps, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Trials do not represent the people who get cancer, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.