Do Lung Cancer Eligibility Criteria Align with Risk among Blacks and Hispanics?

Abstract

BackgroundBlack patients have higher lung cancer risk despite lower pack years of smoking. We assessed lung cancer risk by race, ethnicity, and sex among a nationally representative population eligible for lung cancer screening based on Medicare criteria.MethodsWe used data from the National Health and Nutrition Examination Survey, 2007–2012 to assess lung cancer risk by sex, race and ethnicity among persons satisfying Medicare age and pack-year smoking eligibility criteria for lung cancer screening. We assessed Medicare eligibility based on age (55–77 years) and pack-years (≥30). We assessed 6-year lung cancer risk using a risk prediction model from Prostate, Lung, Colorectal and Ovarian Cancer Screening trial that was modified in 2012 (PLCOm2012). We compared the proportions of eligible persons by sex, race and ethnicity using Medicare criteria with a risk cut-point that was adjusted to achieve comparable total number of persons eligible for screening.ResultsAmong the 29.7 million persons aged 55–77 years who ever smoked, we found that 7.3 million (24.5%) were eligible for lung cancer screening under Medicare criteria. Among those eligible, Blacks had statistically significant higher (4.4%) and Hispanics lower lung cancer risk (1.2%) than non-Hispanic Whites (3.2%). At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes. Blacks eligible rose by 48% and Hispanics eligible declined by 63%. Black men and Hispanic women were affected the most. There was little change in eligibility among Whites.ConclusionMedicare eligibility criteria for lung cancer screening do not align with estimated risk for lung cancer among Blacks and Hispanics. Data are urgently needed to determine whether use of risk-based eligibility screening improves lung cancer outcomes among minority patients.

Estimating eligibility for lung cancer screening in an Australian cohort, including the effect of spirometry

“…There have been four previous estimates of the proportion of the US population who would be eligible for screening (Box 5). 9 , 19 ‐ 21 Three of these studies estimated that 18.8–24.4% of ever‐smokers and 10.5–14.3% of all individuals in the respective age cohorts were eligible for screening according to USPSTF criteria 19 . ‐ 21 These estimates are broadly comparable with our estimates of the proportion of eligible individuals in the BHAS.…”

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

“…The USPSTF eligibility criteria present a challenge for effective implementation of lung screening for African American smokers because these individuals have a higher risk of lung cancer with fewer reported smoking pack-years. 10,12 Within the SCCS cohort, we observed higher absolute rates of lung cancer among African American smokers compared with white smokers, with age-adjusted mortality rates of 39 per 100 000 person-years of follow-up among never-smoking African American individuals and 10 per 100 000 person-years of follow-up among neversmoking white individuals and increasing rates with increasing tobacco consumption regardless of race and type of tobacco product. 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.…”

“…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.…”

“…3,4 African American smokers tend to smoke fewer cigarettes per day compared with white smokers and have a lower overall smoking pack-year history. [5][6][7][8][9][10] Newly published data from the National Cancer Institute Tobacco Control Monograph shows that a larger percentage of adult racial minority populations are light smokers (usually defined as fewer than 10 cigarettes per day) compared with white adults. 11 Despite smoking fewer cigarettes per day and having a lower pack-year history, African American smokers have a higher risk of lung cancer compared with white smokers, particularly among men.…”

The association between HOTAIR polymorphisms and cancer susceptibility: an updated systemic review and meta-analysis

“…First, the populations of included studies were Chinese, Turkish, Iranian, and Portuguese. It is epidemiologically known that other ethnicities such as blacks and Hispanics are also caner susceptible; 47 , 48 thus, the lack of data for these populations might affect the overall results. However, it is worth noting that our stratified analysis may draw a more convincing conclusion for Chinese population.…”