Q & A with Neelima Navuluri, MD, MPH
What inspired you to pursue this particular research project? How did you become interested in cancer screening?
My career goals are to develop and implement interventions to improve the respiratory health outcomes of medically underserved populations in the U.S. and abroad.
My interest in lung cancer screening stems from my experiences as a fellow observing the ways that two different health systems (Duke and the Durham VA Health Care System) had implemented lung cancer screening programs and the disparities I saw in those respective clinics. A disproportionate number of patients presenting to the clinic with early stage, curable lung cancer was White, while many of the Black patients I saw often had a more advanced stage malignancy. This led me to want to better understand why that was, what factors were influencing that disparity, and figure out ways to address it.
Why focus in on Black Veterans? Are there even more disparities in this specific population?
Black men have the highest rates of age-adjusted lung cancer incidence and the highest lung cancer mortality among all US racial and ethnic groups. They are also more likely to develop cancer at an earlier age or present with advanced-stage disease.
In addition, we know that a significant proportion of new invasive lung cancer diagnoses in the U.S. occur among VA Health Care System (VAHCS) users. These individuals are more likely to be African American, unemployed, have a lower annual income, have a higher comorbidity burden, and are more likely to smoke than the general population.
We also know that African Americans are three times less likely to be screened for lung cancer compared to Caucasians.
The Durham VA Health Care System has a well-established screening program, led by my mentor Dr. Shofer. The program offers lung cancer screening at low or no-cost to Veterans. This allows us to assess for and address barriers to screening outside of cost which may be more widely applicable. We hope this will help us identify interventions that can reduce racial disparities in lung cancer diagnosis, treatment and mortality, ultimately having a significant impact on the lives and health of Veterans.
The VA is an interesting place to perform disparities work because many of the financial barriers to care common in the U.S. healthcare system are minimized within the Veterans Healthcare Administration system. However, even in this financially leveled healthcare environment, we still see significant racial differences in lung cancer screening utilization. This project is unique in that we plan to move past simply documenting the disparities among Black Veterans, but will work to understand the barriers to care for these Veterans through patient and provider interviews.
Finally, we will develop, and hopefully implement a pilot intervention to remove the barriers we identify and improve lung cancer screening in this very high-risk population.
We’ll seek further funding for that implementation and testing phase.
Will your project be connected in any way with DCI’s Community Outreach and Engagement efforts, including DCI’s Office of Health Equity, which does a lot of work in the Black community?
I hope so! We as a research team would greatly benefit from their expertise and we plan to engage them as we further develop our research protocol, interview questions, and begin to recruit patients. We also plan to work with the Veteran Research Engagement Panel (VetREP) to get their feedback on our study and research materials and as we move into intervention design.
