Abstract
Lung cancer incidence and mortality disproportionately affect women and racial/ethnic minority populations, yet screening guidelines for the past several years were derived from clinical trials of predominantly White men. To reflect current evidence, the US Preventive Services Task Force (USPSTF) has revised the eligibility criteria, which may help to ameliorate sex- and race/ethnicity-related disparities in lung cancer screening. To determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey. This cross-sectional study included respondents to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System who were 50 to 80 years of age with a smoking history in 19 states that used the optional lung cancer screening module. The change in eligibility among female, male, Black, Hispanic, and White participants was examined. Eligibility by sex and race/ethnicity was compared with a reference population. Data were collected from January 1, 2017, to December 31, 2018, and analyzed from May 8 to June 11, 2020. Self-reported sex, race/ethnicity, age, and smoking history. Lung cancer screening eligibility using the revised USPSTF criteria. The previous criteria included current or past smokers (within 15 years) who were 55 to 80 years of age and had a smoking history of more than 30 pack-years. In the revised criteria, age was modified to 50 to 80 years; smoking history, to 20 pack-years. Among 40 869 respondents aged 50 to 80 years with a smoking history, 21 265 (52.0%) were women, 3430 (8.4%) were Black, and 1226 (30.0%) were Hispanic (mean [SD] age, 65.6 [7.9] years). The revised criteria increased eligibility for the following populations: men (29.4% to 38.3% [8.9% difference]; P < .001), women (25.9% to 36.4% [10.5% difference]; P < .001), White individuals (31.1% to 40.9% [9.8% difference]; P < .001), Black individuals (16.3% to 28.8% [12.5% difference]; P < .001), and Hispanic individuals (10.5% to 18.7% [8.2% difference]; P < .001). The odds of eligibility were lower for women compared with men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P = .04) and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population. The revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
Highlights
In the United States, lung cancer is the leading cause of cancer-related deaths—killing approximately 135 720 people in 2020.1 Despite decreasing incidence of and mortality rates due to lung cancer in the population as a whole, certain minority and vulnerable populations remain at elevated risk
The odds of eligibility were lower for women compared with men and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population
Researchers have highlighted that certain populations were underrepresented in the National Lung Screening Trial, which may have led to screening eligibility and cancer outcome disparities among those who have a higher risk of lung cancer at a younger age with less smoking exposure.[7]
Summary
In the United States, lung cancer is the leading cause of cancer-related deaths—killing approximately 135 720 people in 2020.1 Despite decreasing incidence of and mortality rates due to lung cancer in the population as a whole, certain minority and vulnerable populations remain at elevated risk. The low-dose computed tomography group had a 20% relative reduction in lung cancer mortality.[6] Since this trial, researchers have highlighted that certain populations were underrepresented in the National Lung Screening Trial, which may have led to screening eligibility and cancer outcome disparities among those who have a higher risk of lung cancer at a younger age with less smoking exposure.[7] To reflect current evidence, the USPSTF has revised the lung cancer screening eligibility criteria by lowering the age to 50 years and reducing the smoking history to 20 pack-years, which may help to ameliorate sex- and race/ethnicity-related disparities.[8]
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