# Lung Cancer Screening Participation Among Indigenous Peoples Worldwide: A Systematic Review of Challenges and Opportunities

## TL;DR

This review examines lung cancer screening participation among Indigenous peoples globally, highlighting challenges and opportunities for improving access and outcomes.

## Contribution

The study systematically reviews evidence on LCS participation, facilitators, and barriers specific to Indigenous populations.

## Key findings

- LCS participation rates for Indigenous peoples are lower than for non-Indigenous groups in some regions.
- Culturally competent care and community involvement are key facilitators for LCS participation.
- Barriers include mistrust in healthcare, lack of knowledge, and non-inclusive eligibility criteria.

## Abstract

Lung cancer screening (LCS) is crucial for Indigenous populations due to their higher lung cancer incidence rates and poorer outcomes. Despite efforts to establish LCS programmes, evidence on LCS cost‐effectiveness, participation rates, facilitators and barriers for Indigenous peoples remains limited. This systematic review aims to address this gap by reviewing available evidence.

This systematic review conducted searches for relevant articles in PubMed, Scopus, CINAHL, Google Scholar and references/citations of included articles.

Fifteen out of 19 eligible studies were conducted in the USA, three in New Zealand and one in Canada, with 23 715 Indigenous participants in the 15 quantitative studies. New Zealand studies found that LCS is cost‐effective for Māori, while the participation rate for American Indian/Alaska Natives (4.7%) was lower than for White Americans (21.7%). Facilitators included positive views of LCS, trust in Indigenous‐centred care/providers, trusted invitations, family and community support, transportation or flexible scheduling, culturally competent navigators and detailed health education. Barriers included limited knowledge about LCS/eligibility criteria, fear of the screening process or cancer diagnosis, mistrust or negative experiences in healthcare, cost and time constraints, limited transportation/resources and non‐inclusive eligibility criteria.

Further research is needed to understand the LCS among Indigenous peoples. Enhancing LCS participation requires leveraging positive experiences and addressing barriers with culturally tailored education and strategic resource allocation.

For Australia and similar countries preparing for LCSPs, global evidence highlights the need for adequate resources, integration of Indigenous cultural practices and active involvement of Indigenous communities in programme planning.