Brief Report: Risk Prediction Model Versus United States Preventive Services Task Force 2020 Draft Lung Cancer Screening Eligibility Criteria—Reducing Race Disparities

Abstract

Introduction: Eligibility criteria for lung cancer screening based solely on age and smoking history are less sensitive than validated risk prediction models. The U.S. Preventive Services Task Force (USPSTF) has proposed new guidelines to improve the sensitivity for selecting high-risk individuals and to decrease race disparity. In this retrospective study, termed the Chicago Race Eligibility for Screening Cohort, we compare the sensitivity of the proposed USPSTF2020 criteria versus the PLCOm2012 risk prediction model for selecting a racially diverse lung cancer population with a smoking history for lung cancer screening. Methods: This Chicago Race Eligibility for ScreeningCohort study applies the PLCOm2012 model with a risk threshold of 1.0%/6 years and the USPSTF2020 criteria (age 50-80 y, pack-years 20 y, quit-years 15 y) to 883 individuals with a smoking history diagnosed with having lung cancer.Results: The PLCOm2012 was more sensitive than the USPSTF2020 overall (79.1% versus 68.6%, p < 0.0001) in White (81.5% versus 75.4%, p ¼ 0.029) and in African American (82.8% versus 70.6% p < 0.0001) individuals. Of the total cohort, 254 (28.8%) would not have qualified owing to less than 20 pack-years, quit-time of more than 15 years, and age less than 50 years. Of these 254 cases, 40% would have qualified by the PLCOm2012 model. For the 20 pack-year criterion, of the 497 African American individuals, 19.3% did not meet this criterion, and of these, an additional 31.3% would have qualified by the PLCOm2012 model (p ¼ 0.002).Conclusions: Although more sensitive than USPSTF2013, the proposed USPSTF2020 draft guidelines still have a race disparity in eligibility for screening. This study provides "real world" evidence that use of the PLCOm2012 risk prediction model eliminates this race disparity.

USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study

“…Compared with USPSTF criteria, the PLCOm2012 model with equivalent threshold has been shown to reduce Black versus White race disparities in lung cancer participant selection. 24,34 In this study, the number of minority race groups was too small to analyse separately. This analysis reflects 2•3 years mean follow-up, not 6 years of follow-up for determining lung cancer risk.…”

“…In addition, the CREST study analysis of USPSTF2021 versus PLCOm2012 threshold of at least 1·0% at 6 years (equivalent threshold) found that sensitivity differences remained (68·6% vs 79·1%; p<0·0001). 19 , 20 , 34 Expanding the USPSTF criteria by lowering age and pack-year entry thresholds is unlikely to overcome categoirical eligibility design limitations.…”

Racial and Ethnic Disparities in Lung Cancer Screening by the 2021 USPSTF Guidelines Versus Risk-Based Criteria: The Multiethnic Cohort Study

“…The PLCO m2012 model has been well-validated in selecting high-risk individuals for lung cancer screening (8,9) and includes the following variables: age, race or ethnicity, education, body mass index, chronic obstructive pulmonary disease (COPD), personal history of cancer, and family history of lung cancer as well as smoking status, intensity, duration, and quit time. Risk-based screening through PLCO m2012 reduced racial and ethnic disparities in screening eligibility within observational cohort and simulation studies compared with the 2013 (10,11) and 2021 USPSTF criteria (12). However, these assessments primarily evaluated disparities among African American individuals (12); further assessments among other racial and ethnic groups are lacking.…”

“…Risk-based screening through PLCO m2012 reduced racial and ethnic disparities in screening eligibility within observational cohort and simulation studies compared with the 2013 (10,11) and 2021 USPSTF criteria (12). However, these assessments primarily evaluated disparities among African American individuals (12); further assessments among other racial and ethnic groups are lacking.…”

Addressing Sex Disparities in Lung Cancer Screening Eligibility

“…For this study of sex disparities in screening eligibility, we retrospectively analyzed data from the Chicago Race Eligibility for Screening Cohort (CREST) that have been previously described. 28,29 Briefly, the cases were from a large consecutive case series obtained from the University of Illinois at Chicago Hospital's Cancer Registry. This cohort of a complete and representative lung cancer case series was derived from an urban, community-based thoracic oncology practice at the University of Illinois Hospital & Health Sciences System between 2010 and 2019.…”