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

Abstract

Force (USPSTF) recommends low-dose computed tomography screening for lung cancer. However, USPSTF screening guidelines were derived from a study population including only 4% African American smokers, and racial differences in smoking patterns were not considered. OBJECTIVE To evaluate the diagnostic accuracy of USPSTF lung cancer screening eligibility criteria in a predominantly African American and low-income cohort.

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

“…A secondary analysis of the NLST showed blacks experience a greater reduction in mortality from LDCT screening compared to whites [7]. Despite this finding, blacks may not experience the full benefits of lung cancer screening because blacks are less likely to qualify for screening and are disproportionately less likely to undergo screening [8,21,22]. Blacks are also more likely to be unaware of screening, be underinsured, and have lower socioeconomic status-all factors that contribute to decreased screening rates for lung cancer [7,[11][12][13][14]23].…”

Update on Lung Cancer Screening

“…A further challenge is that the current screening criteria capture only one-third of individuals in the United States who develop lung cancer, 30 and poorly targets African Americans. 34 More information is needed to determine if altering or expanding eligibility criteria to include other known risk factors, as has been suggested by the NCCN group 2, or the use of risk calculators, such as those from the Prostate-Lung Colorectal and Ovarian (PLCO) or Tammemagi's risk could improve capture of patients with early-stage lung cancer. 41 Other potential advances include nodule characterization by three-dimensional volumetric measurements and the use of volume doubling times for improved nodule characterization.…”

Improving Inequities in Lung Cancer Screening: Risk Prediction Models and the Potential to Achieve a Great Equalizer Effect

“…In a prospective cohort study of more than 48,000 individuals who ever smoked, only 17% of blacks were eligible for screening by the U.S. Preventive Services Task Force (USPSTF) compared with 31% of whites. 7 Even more revealing, only 32% of blacks diagnosed to have lung cancer would have been screen eligible compared with 56% of whites. 7 This was due largely to lower smoking histories.…”

“…7 Even more revealing, only 32% of blacks diagnosed to have lung cancer would have been screen eligible compared with 56% of whites. 7 This was due largely to lower smoking histories. Similarly, the current criteria of age capture fewer blacks who are more often diagnosed at an earlier age.…”

“…In essence, risk-based screening preferentially replaces current USPSTF-eligible low-risk, low-benefit individuals who smoke or used to smoke with highrisk, high-benefit individuals who have ever smoked that are currently USPSTF ineligible. 7,12,14,15 Utilizing the PLCOm2012 to determine and stratify participants of the NLST by risk revealed that as risk increased the number needed to screen to detect one lung cancer, false-positive results decreased. 16 That study was published in 2013, so why, then, 7 years after, despite mounting supportive data, has risk-based screening eligibility been largely pushed aside in favor of two very crude variables?…”