The overall goal of this multi-phase research project is to investigate factors that encourage or discourage lung cancer screening. Previous research has shown that exposure to risk information can result in both desired and undesired outcomes: Risk messages can either encourage people to get screened or produce an opposite “boomerang” effect by discouraging people from screening. By drawing on theories of attribution, protection-motivation, and unrealistic optimism, we seek to understand the independent and interactive effects of susceptibility/efficacy, optimistic biases, and internal/external attributional orientation on lung cancer screening attitudes and behaviors. The first phase of this project has three components: (1) an analysis of existing survey data collected from over 4,000 patients who have gotten screened for lung cancer at Weill Cornell Medical College since 2001 to examine how key communication variables might have influenced their decisions; (2) the addition of new communication questions on the patient survey for future data collection and analysis; and (3) the use of a random telephone survey of New York adults (the Empire State Poll) to examine attitudes and behaviors of individuals who have not gotten screened.

Lung cancer kills more men and women in the United States than any other cancer (American Cancer Society, 2007). In 2007 alone, the National Cancer Institute has calculated over 213,000 new cases of lung cancer in the United States and over 160,000 new deaths resulting from the disease (National Cancer Institute, 2007). Among cancers, lung cancer has one of the lowest survival rates, with figures showing that the overall survival rate from 1996 to 2003 was 15 percent (National Cancer Institute, 2007). ung cancer survival rates can potentially greatly increase with early screening, yet the number of individuals getting screened represents only a fraction of the targeted population. In light of these sobering statistics, recent work by faculty at Weill Cornell Medical College showing that early screening for lung cancer can potentially greatly increase survival rates among patients with the disease offers some hope (Henschke, McCauley, Yankelevitz, Naidich, McGuinness, Miettinene, Libby, Pasmantier, Koizumi, Altorki, & Smith, 1999). The research, known as the Early Lung Cancer Action Program (ELCAP), screened 1,000 high-risk patients and found that 80 percent of the lung cancers detected were at the earliest and most curable stage. Further research found that when lung cancers were detected and removed at this earliest stage, the five-year survival rates exceeded almost 70 percent (Henschke, Yankelevitz, Libby, Pasmantier, Smith, & Miettinen, 2006). Weill Cornell Medical College and New York Presbyterian Hospital represent the leading edge of the use of low-dose CT (computed tomography) scans to detect early stages of lung cancer. Currently, the hospital screens approximately 1,000 new patients each year, for a total of approximately 5,000 patients since 2000. Although these figures are promising, the number of people getting screened still represents a mere portion of the population that will contract and die from the disease. A fundamental question is: How should we reach these individuals with information about lung cancer screening? This project lays the groundwork for a multi-year, interdisciplinary, social science-based, communication research program seeking to optimize lung cancer screening rates among U.S. adults.

Phase I of this project, which begins in Spring 2008, entails a series of studies to examine communication influences on lung cancer screening decisions. Guiding questions are: (a) what motivates people to come in for lung cancer screening, (b) where do people who come in for screening get their information about lung cancer screening, and (c) what do people who have not come in for screening know and think about lung cancer screening? Phase I has three corresponding methodological components:
1. Secondary analysis of survey data collected from over 4,000 patients who have come in for screening at New York Presbyterian Hospital. In addition to standard demographic information, these data include information on where patient heard about the ELCAP program, reasons for seeking lung cancer screening, and current health-related behaviors. This dataset offers a wealth of important data on beliefs, attitudes, and behaviors of people who have made a decision to get screened. To this point, no studies have examined these variables in relation to lung cancer screening; thus, we have an opportunity to be the first to publish results on this important topic.
2. The addition to the existing patient survey of several questions asking about specific information sources and subsequent analysis of the responses. Although the current data will allow us to examine some relationships among factors influencing patient motivations for screening, these questions will allow us to more fully understand the information sources to which patients were exposed, as well as assist with the follow-up experiment in Phase II.
3. A survey of adults who have not come in for screening to determine their knowledge and attitudes toward lung cancer screening. By placing questions on the New York Empire State Poll, we plan to collect data from individuals who have not come in for screening. Questions will address whether they have seen information about lung cancer screening, where they get their information.

As the project is in the initial stages of data collection, we are unable to assess impact at this time.

Institute for Social Sciences

Weill Cornell Medical College