Geospatial analysis as a tool for identification of potential targetable regions for lung cancer screening interventions in Massachusetts

We deeply appreciate the constructive response to our recent article “Geospatial analysis as a tool for identification of potential targetable regions for lung cancer screening interventions in Massachusetts” (1) published by Dr. Zolfaghari and colleagues (2). The comments shared reflect honest engagement with our work and their recognition of the urgent need to address persistent disparities in lung cancer screening, and ultimately outcomes.

As they noted, the findings from our manuscript demonstrated the utility of geospatial analysis in ascertaining high-risk groups that would benefit from targeted interventions to improve rates of lung cancer screening. By utilizing the Massachusetts Cancer Registry, our manuscript reported on a concerning association between the proportion of Black residents within a zip code and higher rates of late-stage lung cancer diagnoses among younger patients (<55 years old). We also observed that regions with higher proportions of Black residents were more likely to present with increased overall late-stage disease incidence, lower educational attainment, and lower median income. These findings underscore the intersection of race, socioeconomic status, and structural inequities that continue to shape cancer outcomes.

Our use of geospatial analysis was aimed at augmenting current screening strategies. Specifically, by identifying zip codes with disproportionate burdens of late-stage disease, geospatial tools can help public health agencies and healthcare systems allocate resources more efficiently and deploy interventions where they are most needed. It is imperative that healthcare providers do not use a “one-size-fits-all” strategy when addressing barriers to healthcare among high-risk populations. When combined with community-based approaches, these tools may enhance the precision and equity of lung cancer screening initiatives (3,4).

We strongly agree with the letter’s emphasis on a need to intentionally target screening efforts toward high-need populations. Strategies mentioned include community engagement through efforts such as mobile lung cancer screening programs, partnerships with trusted community leaders, and culturally responsive outreach (5,6). By meeting patients where they are and taking the time to understand the context within which they live, providers can translate epidemiologic findings into meaningful reductions in disparity. Interventions that do no prioritize patient needs will miss the mark in their effectiveness. Identification of high-risk geographic regions is only the first step; sustainable progress requires building trust, reducing structural barriers, and ensuring equitable access to screening and follow-up care.

We appreciate the shared commitment expressed in the letter to improving current screening strategies. Success in this arena will require a combination of grassroots efforts, with hospitals and providers working closely with the patients and communities they serve. Additionally, continued collaboration among researchers, clinicians, public health leaders, and community stakeholders will be critical to closing existing gaps and ensuring that advances in early detection benefit all populations equitably.

We thank the authors again for their thoughtful commentary and for advancing this important discussion.

Supplementary

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Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.