Black Race Remains Associated with Lower Eligiblity for Screening Using 2021 US Preventive Services Task Force Recommendations among Lung Cancer Patients at an Urban Safety Net Hospital

Abstract

Background The 2013 United States Preventive Services Task Force (USPSTF) lung cancer screening (LCS) guidelines were derived from clinical trials of predominantly White men, and lower rates of LCS eligibility have subsequently been found for Black and Hispanic adults. We evaluated whether the revised 2021 USPSTF criteria reduced inequities in LCS eligibility among a racially diverse sample of lung cancer patients. Methods We conducted a retrospective chart review of patients at an urban safety net hospital diagnosed with a primary lung malignancy between 2015-2020. LCS eligibility was determined based on age, pack-years, and smoking status. For all patients and exclusively ever-smokers, χ2 tests were used to evaluate differences in LCS eligibility among demographic variables (race, sex, ethnicity, education level, insurance type) for both the 2013 and 2021 USPSTF criteria. Patients who were ineligible for LCS were categorized by respective reasons. Results Among 678 lung cancer patients (46% female, mean age 66 ± 10 years), 51% were White and 39% were Black. Using the 2013 guidelines, White patients (183 [57%]) would have been more likely to be eligible than Black (89 [37%]) and other-race patients (23 [35%]) (p<0.0001). Using the 2021 guidelines, White patients (220 [68%]) remained more likely to be eligible for LCS than Black (130 [54%]) and other-race patients (31 [48%]) (p=0.0002). The most common reason for ineligibility using the 2013 (183 [50%]) and 2021 (90 [33%]) guidelines was not meeting the pack-years threshold. We identified 88 never-smokers [White (23%), Black (47%)]. Among exclusively ever-smokers, there was no significant difference in eligibility by race under the 2021 criteria [White (73%), Black (65%), other-race (65%); (p=0.48)]. For both the 2013 and 2021 guidelines, sex, ethnicity, education level, and insurance type were not associated with differential screening eligibility among the entire study sample nor exclusively ever-smokers. Conclusion The 2021 USPSTF LCS guidelines may not be sufficient to eliminate racial inequities in LCS eligibility among patients who go on to be diagnosed with lung cancer. Differential rates of lung cancer among never-smokers may contribute to this inequity. Further research is needed to refine LCS guidelines, with particular consideration of non-smoking risk factors.