Differential eligibility of African American and European American lung cancer cases using LDCT screening guidelines

Abstract

IntroductionLung cancer incidence and mortality is higher among African Americans compared with European Americans in the USA where screening guidelines are currently in place and based on age at diagnosis and smoking history. Given the different smoking patterns observed in these populations and the earlier age at which African Americans are diagnosed, it is possible that African Americans will be disproportionally excluded from screening programmes.MethodsWe assessed the capture of African American and EA lung cancer cases using the National Lung Screening Trial, US Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility guidelines in a population of lung cancer cases diagnosed between 1998 and 2014 in the Baltimore region of Maryland (n=1658).ResultsWe found an absolute increase of 3.8% (relative increase: 11.5%) of EA lung cancer cases that fell within the eligible screening guidelines when compared with African Americans. This difference in proportions was not statistically significant (p=0.134). However, differences were more pronounced among women, where an absolute and relative difference of 4.2% and 13.6%, respectively, was observed (p=0.083). As more EA are likely to successfully quit smoking compared with African Americans, the inclusion of the time since quitting variable decreased the relative differences in eligibility.ConclusionsCurrent screening guidelines are projected to capture a higher proportion of EA lung cancer cases than African American cases; however, the differences are not statistically significant. Further studies are needed, especially among high-risk populations, to determine if racial differences in eligibility criteria for lung screening will lead to a widening of cancer health disparities.

Black patients referred to a lung cancer screening program experience lower rates of screening and longer time to follow-up

“…These differences highlight the importance of identifying additional lung cancer risk factors that may disproportionately impact blacks or other vulnerable populations. Multiple investigators have suggested, for example, that black patients would benefit from race-specific adjustment of screening eligibility criteria [22,48,49]. Future research is needed to confirm the preliminary trends identified in this study.…”

Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers

“…22 Our results were consistent with previous studies and support the differential eligibility and exclusion of African American smokers from screening opportunities based on different risk profiles between these racial populations. 10,15,23 Ryan 15 found that a greater proportion of white smokers would be captured with current screening guidelines compared with African American smokers. Pinsky and Kramer 23 analyzed National Health Interview Survey and Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial data and found that the percentage of screening-eligible minority groups and women smokers greatly increased by reducing the selection criteria to include 20-to 29pack-year smokers.…”

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

“…Although smoking prevention and cessation are the most effective interventions in reducing lung cancer incidence and mortality ( 18 ), the implementation and dissemination of high-quality LCS is poised to have a significant effect on reducing lung cancer deaths. However, current USPSTF guidelines do not take into account racial, ethnic, socioeconomic, or sex-based differences in smoking patterns and lung cancer risk and may not optimally select high-risk populations such as underrepresented minorities, PLHIV, or women who have increased lung cancer risk but a lower-intensity smoking history than men ( 4 , 19 – 21 ). A recent study used prediction models to simulate lifetime lung cancer risk and evaluated screening eligibility by USPSTF guidelines and by risk-based criteria (1.3–2.5% risk threshold) for younger (50–54 yr) and older (71–80 yr) individuals ( 22 ).…”