Who Gets Left Behind in Lung Cancer Care?

By Madeleine Burry
July 7, 2026 | VOLUME 4, ISSUE 2

Recent advancements in the prevention, early diagnosis, and treatment of lung cancer have been incredible.

At the beginning of the century, 23% of Americans smoked; as of 2024, fewer than 10% of Americans do so.^1-2 Low-dose CT scans catch lung cancer earlier (when it’s more treatable).³ And each year, treatment options grow more sophisticated and effective, spanning immunotherapy and targeted therapies based on a patient’s particular genetic mutation.⁴

Despite these improvements, lung cancer remains the leading cause of cancer-related death, both in the United States and worldwide.⁵ And the burden is uneven: A person’s race or ethnicity, occupation, income level, geographic location, and other demographic factors can all be linked to higher incidences of and mortality rates from lung cancer.

Origins of lung cancer disparities

Physical access to care

Without an appointment, diagnosis and treatment aren’t possible.

“When I started [at Cheyenne Regional Medical Center] almost two years ago, I was the only full-time pulmonologist in the entire state of Wyoming,” said Rage Geringer, MD, a pulmonary and critical care physician. Rural areas like Wyoming are known for physician shortages, which can lead to lengthy wait times for appointments and long journeys for patients.⁶

“I saw a patient yesterday who drove 11 hours roundtrip just to see me,” Dr. Geringer said.

Distance to care is particularly problematic for rural populations because they typically have a higher level of mortality from cancers, specifically lung cancer.^7-8 Contributing to this finding, people living in rural areas are more likely to smoke (15% compared with 10% in urban areas) and also more likely to smoke heavily.⁹ Rural areas are also home to more people working in professions such as farming or construction, where smoking is more prevalent.⁹ 

Proximity to adequate health care is also a key factor for Indigenous people living on reservations. “My reservation that I live on is equivalent to the size of Connecticut,” said Jordyn Gunville-Pourier, PhD, MPH, a public health scientist from the Miniconjou Lakota nation.

Compared with White individuals, Native Americans are less likely to be diagnosed early or receive surgical treatment (or any treatment at all), according to the American Lung Association.¹⁰

When a provider’s office is 100 or more miles away, appointments can’t be squeezed into a lunch break; they require time off from work and caretaking support. That’s costly, as is filling a vehicle’s tank with gasoline. For people with low incomes or who live in poverty, health needs must be balanced with day-to-day survival. “They have to make hard decisions: Should I go to the doctor, or should I buy food for the month?” Dr. Gunville-Pourier said.

On reservations, there’s another obstacle: fragmented care. Indigenous people navigate referral systems spanning the Indian Health Services, Tribal 638 facilities (which are federally funded and run by Native Americans), Medicaid, and outside specialty systems, Dr. Gunville-Pourier explained.

“Every handoff creates a place where people can fall through the cracks,” she said.

That may be partially because doctors and clinicians are aware that incidences of smoking and lung cancer are lower among Latino individuals, Dr. Cartujano-Barrera said.¹³ Also, nondaily smoking and light smoking (fewer than 10 cigarettes per day) are common among Latino individuals, and these habits are often perceived as low risk and socially acceptable. (It’s worth noting that Latino, Black, and Asian individuals are all less likely to receive an early diagnosis compared with White individuals.)¹⁴

The uptake of lung cancer screening is low among Latino groups compared with the general population, Dr. Cartujano-Barrera said. “Whenever we go out in the community and we talk to Latinos, it’s not rare that they say, ‘I didn’t know that lung cancer screening existed.’ And it’s also not rare for us to hear them say, ‘I didn’t even know I was eligible,’ even when they meet the eligibility criteria,” he said.

Patients who aren’t fluent in English or don’t speak the predominant language may require an interpreter, which can delay appointments and can have a negative impact on the quality of the visit, Dr. Cartujano-Barrera said.

Dr. Cartujano-Barrera also used eye-catching materials for outreach efforts, including a huge, inflatable lung and pig lungs that show the difference between smoke-exposed lungs and healthy lungs. “People either love or hate the pig lungs, but usually there’s a reaction,” he said.

In his experience, interactions and interventions that consider patients’ cultures and backgrounds can lead to great success.

“For example, familism—a strong value in many Latino communities—places great importance on family relationships and responsibilities. Latinos are often motivated to quit smoking to protect their family’s health and be a positive role model for their children. Interventions that acknowledge and incorporate these family-centered motivations may be more relevant and engaging,” Dr. Cartujano-Barrera said.

A personal touch

Transportation. Language barriers. Scheduling appointments. Navigating confusing medical systems, terminology, and follow-up steps.

Getting care isn’t easy, but community health workers can help people bridge the gap between clinics and home, Dr. Gunville-Pourier said. In Wyoming, Dr. Geringer takes on a lot of this effort. “I try to make it as easy as possible for the patient,” he said.

To do so, he reaches out: “I call every patient personally, which is something you have to do in the rural areas that I never did in the urban areas, to try to coordinate getting them seen,” he said.

He makes a point to call out-of-town patients who have high-risk lesions and long drives to explain next steps and help coordinate their appointments. During appointments, he walks them through the process he’s already discussed on the phone and then gets their pre-operative CT scan. Patients stay overnight in Cheyenne (if they don’t have friends nearby, his office helps coordinate hotel vouchers). Their procedure takes place first thing the next morning. “Then [we] try to get them back home, so they’re not out of their hometown for more than 24 to 30 hours,” Dr. Geringer said.

The personal touch matters. When he calls, he tells them his name, says how far he is from where the patient lives, and mentions whether he knows their children or grandchildren. “You try to relate to them on a personal level,” Dr. Geringer said.

Lower the threshold to entry

In other communities, there are higher-tech, more scalable ways to meet patients where they are.

In a randomized controlled trial, Dr. Cartujano-Barrera and his fellow researchers found that text message interventions helped Latino patients quit smoking.²¹ The text messages were aimed at addressing some of the barriers in the community (such as the lack of clinicians who are inquiring about smoking, encouraging cessation, or have materials available in Spanish), and they’re developed to be culturally relevant. As a follow-up project, Dr. Cartujano-Barrera is using electronic medical records to identify Latino patients who smoke in an effort to increase participation in the text messaging program.²²

Another strategy that Dr. Gunville-Pourier recommends to improve access is implementing mobile low-dose CT scans, which would remove the need for long drives and allow for same-day screenings.

Connect with colleagues

Dr. Geringer makes an effort to meet face to face with health care providers, crisscrossing Wyoming to do lunch-and-learns and discuss ongoing trials, the benefits of lung-cancer screenings, and what insurance does and doesn’t cover, as well as other pulmonary education for asthma and COPD.

“In Wyoming, we’re behind on a lot of lung health,” Dr. Geringer said. Through in-person connections, he’s building pathways so that primary care providers can make informed recommendations, helping people who qualify for low-dose screenings make the appointments or get the referrals they need.

Growing health care knowledge is also a priority for Dr. Gunville-Pourier. A CHEST grant is helping children in her Lakota community become health ambassadors through embracing their lung health, teaching health literacy, serving as role models, and learning the difference between commercial and traditional tobacco.

Pushing forward

Despite hefty obstacles, small shifts can make a real difference. Each of the examples highlighted—expanding one’s cultural awareness, seeking out clinical trials, using alternative communications tools like texting, increasing patient education—creates opportunities to improve patient care and increase the likelihood of early intervention. Explore what is needed for your patient community by asking critical questions about transportation, financial barriers, and personal fears.

“If we work together with the community,” Dr. Cartujano-Barrera said, “then we’re going to start seeing some real changes.”