Lung Cancer Screening Outreach for Asian Americans: “Passive” Doesn’t Cut It

To reach patients who are hit hardest by lung cancer and disproportionately underserved by screening programs, Jeffrey B. Velotta, MD, FACS, found ways to get the word out in their communities, among their peers, and in their preferred languages.

Dr. Velotta’s 2023 TSF Reversing Health Disparities in Lung Cancer Research Award helped his team deploy “patient navigators” to Asian American communities, where they demonstrated that an active approach beats a passive one for getting the word out about screening and smoking cessation resources.

Hailing from the University of California San Francisco (UCSF) School of Medicine and the Kaiser Permanente Northern California health care system, Dr. Velotta works among diverse communities of people with ancestry in the Far East, Southeast Asia, the Indian subcontinent, and the Pacific islands.  

“Asian Americans make up the majority of the population of the Bay Area—more than Caucasians,” Dr. Velotta explained. “But they are traditionally underserved. Many Asian American patients diagnosed with late-stage lung cancer were never offered screening. In fact, in our early data we found that, even with health insurance coverage, Asian Americans were the least likely to adhere to lung cancer screening guidelines.”

While heart disease remains the leading cause of death in Americans overall, it’s cancer—and more specifically, lung cancer—that claims the most lives among Asian American populations, Dr. Velotta pointed out. Statistically, Chinese, Filipino, and Vietnamese Americans suffer the highest lung cancer mortality, he said.

Navigators and Family Foster Effective Conversations

Dr. Velotta’s team posited that the most effective way to improve lung cancer screening in these high-risk groups was to organize community health workers and employ culturally adapted strategies with telehealth services.

But a hypothesis must be tested against solid data. The team identified and randomized a group of 1,000 Asian American patients within the Kaiser Permanente Northern California health system who were eligible for lung cancer screening but hadn’t yet undergone a screening exam.

Among this group, they approached 500 with “passive” outreach, emailing them with information about nearby lung cancer screening services, explaining their eligibility for lung cancer screening services based on their smoking history.

“The emails were written in English, though we have a future study planned to send emails in patients’ preferred native language,” Dr. Velotta explained.

The other 500 patients were contacted with “active” outreach, with a dedicated volunteer, called a patient navigator, assigned to communicate directly with the patient over the phone. “If English was not their preferred language, navigators utilized our health system’s translation services,” Dr. Velotta explained. “They also relied heavily on family members who spoke English—and this emphasizes that cultural and familial interactions are vital for this process to work even more effectively.”

Both patient groups were matched for age, gender, pack-years smoked, recent smoking status, primary language, service region, and home facility.

“Through my initial interactions and volunteer services with Bay Area Asian community organizations, we felt that communicating through lay patient navigators would be the most impactful to help patients get into shared decision-making and receive a low-dose CT scan easier and earlier,” Dr. Velotta said.

After months of follow-up, data collection, and analysis, Dr. Velotta’s team found that participants in the “active” outreach group had significantly higher referrals for lung cancer screening, were significantly more likely to participate in shared decision-making meetings, and yielded a higher rate of orders for low-dose CT scans.

Results Lay the Foundation for Lifelong Work

Dr. Velotta presented the findings at the STS Annual Meeting in January 2025 in Los Angeles. The complete analysis is scheduled to be published in The Annals of Thoracic Surgery.

Those aren’t the only professional achievements for which he credits his TSF Reversing Health Disparities in Lung Cancer Research Award. He has also earned speaking engagements and become a global faculty member with Stanford University Center for Asian Health Research and Education, the 2024 Kaiser Permanente Northern California/Stanford University PEARLS Community Seminar Lectureship on Lung Cancer Screening and Epidemiology in Asian Americans, the Bay Area Chinese Culture Salon Lectureship on Asian Women’s Health Awareness, and the Go2 for Lung Cancer Summit Center of Excellence Annual Conference. And he’s been awarded the mid-career faculty award by the Society of Asian Academic Surgeons.

“The TSF Reversing Health Disparities in Lung Cancer Research award helped immensely; it is everything,” Dr. Velotta said. “It allowed much-needed funding for a research pilot that, even though cancer is the number one killer in Asian Americans, many bigger institutions such as the NIH deemed not relevant or important enough. It is so beneficial for my future research, grants, and publications to have the data we collected from this TSF award.”

Dr. Velotta is now working on expanding the study cohort and exploring ways that patient navigators can play a larger part in shared decision-making discussions. His aim is to help save clinicians’ time and resources while getting patients referred for low-dose CT screening more quickly and easily.

He’s also working on a pilot program that helps deliver patient education in languages including Mandarin, Cantonese, Vietnamese, Korean, Hindi, Japanese, and Tagalog.

To his colleagues in thoracic surgery, Dr. Velotta says, “STS is a great organization for thoracic surgeons of all ages and experience levels. I encourage everyone to apply for the generous awards provided by The Thoracic Surgery Foundation, because it can make a world of difference in your career.”