Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility

Abstract

Background:In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation to expand lung cancer screening (LCS) eligibility and mitigate disparities. Although this increased the number of non-White individuals who are eligible for LCS, the update's impact on drivers of disparities is less clear. This analysis focuses on racial disparities among Black individuals because members of this group disproportionately share late-stage lung cancer diagnoses, despite typically having a lower intensity smoking history compared to non-Hispanic White individuals. Methods:We used data from the National Health Interview Survey to examine the impact of the 2021 eligibility criteria on racial disparities by factors such as education, poverty, employment history, and insurance status. We also examined preventive care use and reasons for delaying medical care.Results: When comparing Black individuals and non-Hispanic White individuals, our analyses show significant differences in who would be eligible for LCS: Those who do not have a high school diploma (28.7% vs. 17.0%, p = 0.002), are in poverty (26.2% vs. 14.9%, p < 0.001), and have not worked in the past 12 months (66.5% vs. 53.9%, p = 0.009). Further, our analyses also show that more Black individuals delayed medical care due to not having transportation (11.1% vs. 3.6%, p < 0.001) compared to non-Hispanic White individuals. Conclusions:Our results suggest that despite increasing the number of Black individuals who are eligible for LCS, the 2021 USPSTF recommendation highlights ongoing socioeconomic disparities that need to be addressed to ensure equitable access.

Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility

“…To date, the key effort to reduce racial disparities in lung cancer screening eligibility was the revision of the 2013 USPSTF guideline to lower the age limit and reduce the number of smoking pack-years required. 13,35 However, our findings, in addition to the findings of several previous studies, [4][5][6][7][8][9][10][11] demonstrate that these previous changes were unsuccessful in eliminating racial disparities in screening eligibility. Importantly, revising the guideline to include a 20-year smoking duration cutoff instead of a 20-pack-year cutoff completely eliminated the racial disparity between Black and White individuals in screening eligibility.…”

“…3 However, many individuals at high risk for lung cancer, especially those from racial and ethnic minority groups, are ineligible because they have too few pack-years of smoking. [4][5][6][7][8][9][10][11] Pack-year smoking history-a composite measure based on smoking intensity and smoking duration-is a widely accepted clinical tool to quantify an individual's tobacco exposure and assess their risk of lung cancer. 12,13 However, the use of pack-year smoking history to determine lung cancer screening eligibility is based on historic precedent, emerging from its use as an eligibility criterion in the National Lung Screening Trial (NLST).…”

“…We chose to focus on the disparity in screening eligibility between Black versus White individuals because (1) Black individuals face a disproportionate burden of lung cancer in the United States, with Black individuals more likely to be diagnosed with advanced-stage lung cancer 28,29 and to have worse survival compared with White individuals, 28,30 and (2) there is a large body of evidence supporting a marked disparity in screening eligibility between Black versus White individuals. [4][5][6][7][8][9][10][11]…”