Currently recommended lung cancer screening guidelines may be insufficient for high-risk minorities.

Abstract

Inadequate screening guidelines for underserved populations could help to explain racial disparities in lung cancer outcomes according to researchers at the University of Illinois at Chicago (UIC) Cancer Center. The team compared patients in a Chicago-based lung cancer screening program with those enrolled in the National Lung Screening Trial (NLST), a large-scale study of current and former smokers sponsored by the NCI. In 2011, findings from the NLST led to new guidelines that recommended screening for lung cancer based on specific ages and smoking histories. UIC researchers wanted to see how the national screening data compared with baseline screening data from a diverse urban population in which some of the patients were treated at federally qualified health centers. Their study group consisted of 500 male and female patients with a mean age of 62 years at the University of Illinois Hospital and Clinics or its federally qualified clinic network, the University of Illinois Health Mile Square Health Center. The study found that the participants in the NLST were not representative of the US population as a whole, particularly with respect to minorities.1 The Chicago-based screening program, for example, had higher proportions of black and Latino participants than the NLST population (69.6% vs 4.5% and 10.6% vs 1.8%, respectively). At the same time, the Chicago screening program resulted in double the frequency of positive scans (24.6% vs 13.7%) and a higher percentage of diagnosed lung cancer cases (2.6% vs 1.1%) than the national trial. Although new lung cancer treatments such as precision medicine and immunotherapy are improving both the length and quality of life for many patients, some underrepresented groups may not be receiving these benefits because they have trouble accessing or do not qualify for screening programs, says senior author Lawrence Feldman, MD, an oncologist and associate professor of clinical medicine at UIC. When screening is offered only according to age and smoking history, it may overlook populations that are at higher risk from other factors, he notes. One observed disparity is the fact that African Americans are more likely to be diagnosed with and die of lung cancer than other groups according to the American Lung Association. For example, African American men are 22% more likely to die of the disease than their white male counterparts. The authors suggest that other risk factors should be considered in screening recommendations for the disease. They include a history of chronic obstructive pulmonary disease; having a close relative with lung cancer; and other socioeconomic factors, such as a lower level of education. Taking into account these additional factors could be an important step in helping to close the disparity gap, they note.