Do the 2013 United States Preventive Services Task Force guidelines for lung cancer screening fail high-risk African American smokers? An institutional retrospective observational cohort study

Abstract

Background Lung cancer cause nearly 1.76 million deaths worldwide in 2018. In 2011, the National-Lung-Cancer-Screening-Trial showed 20% relative risk reduction with LDCT and subsequently led to the current USPSTF screening guidelines. However, the predominant focus on elderly, Caucasian questions its generalizability to communities with young, African Americans such as our institution. Hence, the objective of our study is to investigate the need to modify the current screening guidelines at our institution by assessing the applicability of newer individual risk-based prediction models for LDCT screening.Methods This is a retrospective observational cohort study of newly diagnosed lung cancer patients at LSU Health Sciences Center Shreveport from 2011 to 2015. One-third of the patients did not meet the current USPSTF screening guidelines. We categorized them into high-risk (groups1 and 2), moderate-risk, and low-risk according to 2018 NCCN Lung Cancer Screening Guidelines Version 1.2020. The high-risk groups were differentiated using the Tammemagi lung cancer risk calculator. ResultsAmong those who did not meet the screening guidelines, nearly 50% were African American, 95% with known smoking history, and 80% diagnosed at advanced stage at the time of diagnosis. After employing the Tammemagi Risk based calculator, 12.5% were categorized into high-risk group 2, who are also eligible for annual LDCT. ConclusionThe current USPSTF guidelines have failed in our population consisting of young African American smokers, questioning the health disparity in medicine. By employing individual risk-based prediction models, we could potentially identify tailored high-risk populations leading to appropriate use of LDCT screening. European

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“…Thurlapati, 2021 [61] 2018 NCCN Lung Cancer Screening Guidelines revised using an individualized risk-based Tammemagi Calculator to determine who should be screened for lung cancer One-third of patients diagnosed with lung cancer did not meet the 2103 screening guidelines. Using the revised NCCN guidelines, 12.5% who were ineligible for screening would have been qualified for LDCT; however, 87.5% of those patients with lung cancer who were missed would still not have met screening criteria.…”

“…Olazagasti et al [50] found that significantly more Hispanic/Latinx patients did not qualify for screening based on USPSTF guidelines; eligibility rates did not differ between African Americans and those who were White, Asian, or other races when comparing the two guidelines. Thurlapati et al [61] found that one-third of patients with lung cancer did not meet the 2013 USPSTF guidelines, and, of those, only 12.5% would have been eligible for screening based on revised NCCN guidelines using an individual risk-based calculator. Among those who would not have met eligibility criteria, 50% were African American.…”

“…We found several studies that compared screening methods to produce a better lung cancer risk determination among people who identify as BIPOC [50,53,61]. Alternative risk prediction models may more accurately identify Black or African American patients at increased risk for lung cancer [53,61].…”