# Investigating the Roles of Patient Beliefs, Stigma, and Physician Implicit Bias on Disparities in Lung Cancer Screening

> **NIH NIH R01** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2021 · $809,758

## Abstract

Lung cancer is particularly aggressive, lethal, and stigmatized by its strong association with
cigarette smoking, with a 5-year survival rate <15%. The burden of lung cancer in the United
States falls disproportionally on minorities. Blacks have the highest incidence of lung cancer and
both Black and Hispanic patients have worse outcomes than their white counterparts. Lung
cancer screening, consisting of an annual low-dose computed tomography (LDCT) scan, is
currently recommended by the United States Preventive Services Task Force to the 8 million
smokers who are at high risk of developing lung cancer, and is poised to substantially reduce
lung cancer deaths. Alarmingly, emerging national data demonstrates that only 3% of black
eligible smokers received screening compared to 12% of white smokers in 2017. Prior research
on cancer disparities fails to address issues that are specific to lung cancer (stigma, high
mortality, and fatalism) and LDCT screening (new test, increased radiation exposure) and
greatly limits the generalizability of the findings from these studies to lung cancer screening. In
this project, we plan to assess modifiable health beliefs as well as examine psychological
responses to discrimination, such as stigma and medical mistrust that may influence lung
cancer screening use among minority smokers. We also plan to evaluate the role of implicit bias
among physicians. Given the newness and unique challenges of lung cancer screening, efforts
to accurately identify barriers and engage Black and Hispanics in LDCT screening early in its
adoption are imperative to achieving an early correction to this disparity. The Specific Aims of
the study are to: 1) Assess racial and ethnic differences in beliefs about lung cancer and LDCT
screening and their association with lower rates of agreement to undergo screening and LDCT
completion; 2) Evaluate if racial and ethnic differences in stigma and medical mistrust are
associated with lower rates of agreement to undergo screening and LDCT completion and
underlie screening disparities; and 3) Assess the association of implicit bias with racial and
ethnic disparities in lung cancer screening referral and LDCT completion. To achieve these
aims, we will recruit lung cancer screening-eligible smokers and their primary care providers
from a vast network of primary care practices in New York City. We plan to measure patient’s
beliefs about lung cancer and LDCT screening, stigma, and medical mistrust, as well as
measure physicians’ bias and test associations with lung cancer screening referral and
completion. The results of the study will directly guide the development of targeted strategies to
improve lung cancer screening rates among minorities.

## Key facts

- **NIH application ID:** 10120286
- **Project number:** 1R01MD014890-01A1
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Minal S Kale
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $809,758
- **Award type:** 1
- **Project period:** 2021-09-20 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10120286

## Citation

> US National Institutes of Health, RePORTER application 10120286, Investigating the Roles of Patient Beliefs, Stigma, and Physician Implicit Bias on Disparities in Lung Cancer Screening (1R01MD014890-01A1). Retrieved via AI Analytics 2026-06-10 from https://api.ai-analytics.org/grant/nih/10120286. Licensed CC0.

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