Abstract
The potential to achieve greater reductions in lung cancer mortality than originally estimated by the National Lung Screening Trial with the inclusion of more Black participants stresses the importance of improving access to lung cancer screening for Black current and former smokers, a population presently with the highest lung cancer morbidity and mortality. To estimate lung cancer and all-cause mortality reductions achievable with lung cancer screening via low-dose computed tomography (LDCT) of the chest in populations with greater proportions of Black screening participants than seen in the original NLST cohort. This cohort study was conducted as a secondary analysis of existing data from the National Lung Screening Trial, a large national randomized clinical trial conducted from 2002 through 2009. NLST participants were current or former smokers, aged between 55 and 74 years, with at least 30 pack-years of smoking history and less than 15 years since quitting. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% CIs of lung cancer mortality and all-cause mortality according to LDCT screening compared with chest radiograph screening. Using a transportability formula, we estimated outcomes for LDCT screening among hypothetical populations by varying the distributions of Black individuals, women, and current smokers. Data were analyzed between September 2020 and March 2021. Lung screening with LDCT of the chest compared with chest radiography. Lung cancer mortality and all-cause mortality. This study included a total of 53 452 participants enrolled in the NLST. Of 2376 Black individuals and 51 076 non-Black individuals, 21 922 (41.0%) were women and the mean (SD) age was 61.4 (5.0) years. Over a median (interquartile range) follow-up of 6.7 (6.2-7.0) years, LDCT screening among the synthesized population with a higher proportion of Black individuals (13.4%, mirroring US Census data) was associated with a greater relative reduction of lung cancer mortality (eg, Black individuals: HR, 0.82; 95% CI, 0.72-0.92; vs entire NLST cohort: HR, 0.84; 95% CI, 0.76-0.96). Further reductions in lung cancer mortality by LDCT screening were found among a hypothetical population with a higher proportion of men or current smokers, along with a higher proportion of Black individuals (ie, 60% Black participants; 20% to 40% women) (HR, 0.68; 95% CI, 0.48-0.97). The potential to achieve greater reductions in lung cancer mortality than originally estimated by the NLST with the inclusion of more Black participants stresses the critical importance of improving access to lung cancer screening for Black current and former smokers.
Highlights
Lung cancer is the third most common cancer in the US, and the leading cause of cancer-related death.[1]
Over a median follow-up of 6.7 (6.2-7.0) years, low-dose computed tomography (LDCT) screening among the synthesized population with a higher proportion of Black individuals (13.4%, mirroring US Census data) was associated with a greater relative reduction of lung cancer mortality
Further reductions in lung cancer mortality by LDCT screening were found among a hypothetical population with a higher proportion of men or current smokers, along with a higher proportion of Black individuals (HR, 0.68; 95% CI, 0.48-0.97)
Summary
Lung cancer is the third most common cancer in the US, and the leading cause of cancer-related death.[1]. The landmark National Lung Screening Trial (NLST), a large randomized clinical trial involving 53 452 participants enrolled between 2002 and 2004, demonstrated a 20% reduction in lung cancer mortality with annual lung cancer screening using low-dose computed tomography (LDCT) of the chest when compared with chest radiograph.[3] In light of the results of the NLST and a 2014 comparative modeling study,[4] the US Preventive Services Task Force (USPSTF) issued a grade B recommendation that current and former smokers between ages 55 and 80 years with a 30 packyears or more smoking history and with 15 or less years since quitting receive annual lung cancer screening with LDCT. The USPSTF has expanded lung screening eligibility to include current and former smokers between ages 50 and 80 years with 20 pack-years or more of smoking history and 15 or less years since quitting.[7]
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