PILOT PROJECT: SUMMARY ABSTRACT Each year, 206,000 people in the US are diagnosed with lung cancer, and 160,000 die of this disease. Lung cancer incidence and mortality rates, which vary by sex and race, are currently decreasing slowly, but the rates are higher among African American (AA) males compared to their White counterparts. In Alabama and Georgia, high lung cancer incidence and mortality rates are attributed to high smoking rates among underserved and low- income populations. In the US, only 15% of lung cancers are diagnosed at the localized stage, resulting in a poor overall five-year survival of 17%, but early detection could avert approximately 12,000 lung cancer deaths per year. The National Lung Screening Trial (NLST) documented a 20% reduction in lung cancer mortality among those screened. Thus, in 2013, the US Preventive Services Task Force (USPSTF) began recommending annual screenings for lung cancer with low-dose CT scans (LDCT) for adults aged 55–80 years who have a history of 30-pack-year smoking and either currently smoke or have quit within the past 15 years. Yet, only 3.9% of eligible individuals underwent screening in 2015. When lung cancer is detected at a local stage (Stage I or II), the 5-year relative survival rate for AAs is 47%; however, only 15% of lung cancer cases in AAs are detected early, and lung cancer screening (LCS) for AAs is half of that for White populations. Consistent with the national number, 4.2% of those eligible in Alabama and 4.4% of those eligible in Georgia have been screened for lung cancer, with no known literature on the sociodemographic breakdown. Although LCS uptake is low among all eligible individuals, individuals of lower income and those who face barriers to care are likely to be the left behind in the implementation of LCS programs. We propose to collect LCS data at Grady Memorial Hospital (Atlanta) and at the University of Alabama at Birmingham (UAB). For these institutions, there is no current information regarding uptake patterns of LCS. For many patients, the point of first contact with the healthcare system are providers who can be involved in recommending LCS tests to and/or interpreting their results for patients. The availability of proven strategies that can reduce lung cancer deaths warrants immediate study of the determinants that limit maximal use of LCS across areas of greatest need, in particular, high-risk regions in the Southeastern US. Thus, the objectives of this joint project between Morehouse School of Medicine and UAB are to characterize patients who were screened and not screened for lung cancer; examine patterns of uptake to LCS in two different health care systems; and explore barriers and facilitators to LCS at the system, provider, and patient levels for the development of a multi-level intervention. In accordance with the overall mission of the U54 Partnership between MSM, TU, and the UAB OCCC, this research will enhance our understanding of cancer disparities ...