A new research project in Minnesota hopes to save lives in rural parts of the state by increasing the number of people who recommend lung screening.
Getting to people in rural parts of the state may come down to getting more people in a rural doctor’s office to recommend lung cancer screening to patients, according to Dr. Abbie Begnaud of the Masonic Cancer Center at the University of Minnesota, who is working with the Minnesota Cancer Clinical Trials Network to increase lung cancer screening across the state.
“Anybody with lungs can get lung cancer, and, when found early, lung cancer survival rates can reach 80% to 90%,” Begnaud told the Daily Yonder. “The problem is that less than 20% of eligible Minnesotans are actually screened for lung cancer.”
As part of the center’s pilot program, Begnaud worked with six primary care clinics to involve the entire clinic staff to identify patients who may need screening, to help patients see if they are eligible for screening, and to help get those screenings scheduled.
The goal, she said, was to help overcome the barriers some rural residents face when it comes to scheduling those screenings.
Lung screening is recommended for people who are over age 50 and have a history of heavy smoking. While rural residents have higher smoking rates, they may have less access to imaging centers or more problems with scheduling. And there are psychological barriers that may need to be addressed as well, Begnaud said.
“All the public service announcements and packages and warnings and everything that we’ve been doing over the last several decades have decreased the smoking rate, but they have also led to stigma and shame around cigarette smoking,” she said.
“So, people who have smoked or continue to smoke are certainly aware that it’s bad for their health, and they know that everyone else is thinking about it. I think they internalize these messages of blame… It’s really important to get people to be open to screening to try to decouple the kind of shame or blame that goes along with (smoking).”
Nationally, as of 2023, 10.8% of adults smoke cigarettes, according to the American Lung Association. While that remains one of the lowest rates recorded for this decade, there are disparities between different parts of the country. The U.S. Surgeon General found in 2024 that 15.4% of rural adults smoke, compared to 10.1% of urban adults. Additionally, those rural residents who do smoke tend to smoke more, averaging 15 or more cigarettes per day. And, the Surgeon General’s report found, youths in rural areas are more likely to start smoking at a younger age and to smoke daily.
The Surgeon General’s report also found that rural adults in the Midwest and Southeast (Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee, and West Virginia) are 40% more likely to smoke than adults in the Northeastern and Western states. And rural adults are more likely to have difficulty quitting, the report said.
“People who live in rural areas experience tobacco-related health disparities. Compared with people who smoke and live in urban areas, people in rural areas who smoke tend to have worse cessation-related outcomes when attempting to quit and are more likely to die from a tobacco-related disease,” the report said. “Quit ratios and the prevalence of a past-year quit attempt have also been significantly lower among people who smoked cigarettes and lived in rural counties than among those who lived in large central metropolitan areas.”
Even if rural adults agree to get screened, getting the appointment scheduled can be another barrier. Typically, Begnaud said, patients are handed information to make their own appointments, which may prove to be difficult or which patients may put off. By invoking a whole-of-office approach, it’s possible to get the appointment scheduled while they are in the office instead of forcing patients to navigate the process alone.
What researchers found with the pilot program was a 30% increase in the number of screening orders for eligible patients. Now, she said, she wants to take it to statewide trials and include more rural clinics.
“What we really wanted to see was: ‘Is this approach feasible? Is this doable in clinics?’ And largely, the answer to that is ‘yes,’” she said.
“In the clinics that we’ve worked in, the entire clinic teams were excited to learn more about it and excited to work on this project. But because it was a small pilot, we didn’t get enough data to say that ‘This absolutely helps to increase the screening rates,’ but we did get enough data to say this is something that might work, and we need to test on a larger scale.”
Begnaud said the results and her work as a pulmonologist and associate professor at the University of Minnesota Medical School push her to do more to help rural residents, and this research has found a way to strengthen care for people in rural communities who face more barriers to access.
“My clinical work as a lung specialist motivates me,” she said. “Every time I see somebody who comes to me who should have been screened and wasn’t, and now they have a stage 3 or a stage 4 lung cancer, it motivates me to get up and work harder tomorrow, because there’s still a lot of work to do.”
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