Black People are Under Counted in Current Lung Cancer Screening Guidelines

A new study published in the Journal of Thoracic Oncology shows that public health screening guidelines for lung cancer followed by the United States Preventive Services Task Force (USPSTF) and the Center for Medicare and Medicaid Services (CMS) undercount African Americans, thus contributing to health disparities in lung cancer screening and treatment.

Current USPSTF and CMS guidelines, per a press release, recommend low dose computed tomography screening for individuals that meet the following criteria: age 55-80 or 55-77 years, 30 or more pack-years cigarette smoking history, and in former smokers having quit smoking within the past 15 years. However, Black Americans are more likely to start smoking at a later age, smoke fewer cigarettes per day, have a longer duration of smoking, are less likely to quit, and tend to be diagnosed with lung cancer at an earlier age.

In this study, researchers performed a retrospective analysis of 1,050 patients with thoracic cancer from their cancer registry. They assessed the cohort for whether each case would have been eligible by USPSTF criteria for screening based on age, pack-years (average packages of 20 cigarettes smoked per day times years smoked) and quit time. After some exclusions, the cohort of 883 ever-smokers was comprised of the following racial/ethnic makeup: 258 (29.2%) White, 497 (56.3%) African American, 69 (7.8%) Hispanic, 24 (2.7%) Asian, and 35 (4.0%) other. Subsequently, the researchers analyzed this cohort using the PLCOm2012 lung cancer risk prediction screening model, which incorporates 11 predictors, including sociodemographic, medical history, and four smoking exposure variables.

“We found that the PLCOm2012 model was significantly more sensitive in selecting lung cancer patients as being eligible for screening for the entire cohort,” said lead author Mary Pasquinelli, DNP, from the University of Illinois at Chicago via the release. “Broader use of this model in racially diverse populations may help overcome disparities in lung cancer screening and outcomes.”

“Black and Hispanic patients are underrepresented in cancer clinical trials and COVID-19 trials, even though they are more likely to be more affected by both diseases,” said Janet Freeman-Daily at the IASLC World Conference on Lung Cancer Virtual Presidential Symposium. “In a rapid moving area like cancer care, clinical trials are treatment and represent hope.”