P1.11-03 Disparities and National Lung Cancer Screening Guidelines in the U.S. Population

Abstract

Current U.S. Preventive Services Task Force (USPSTF) lung cancer (LC) screening guidelines are based on smoking history and age (55-80). These guidelines may miss those at higher risk, even at younger ages, due to other risk factors such as race or family history. In this study, we characterize the demographic/clinical profiles of those who are selected by risk-based screening criteria, but missed by USPSTF in younger (45-54) or older ages (71-80). We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and logistic prediction models for non-smoking risk factors to simulate life-time LC risk-factor data for 100,000 men and women in the U.S. 1950-1960 birth cohorts. We calculated age-specific 6-year LC risk (r) for each individual from ages 45-90 using the PLCOm2012 model. We evaluated age-specific screening-eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3%-2.5%). In the 1950 cohort, 6.73% would be missed for screening in their younger ages by the USPSTF-criteria, but would have been screened by the risk-based criteria. Similarly, 13.97% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, a higher proportion of African Americans will be ineligible for screening by USPSTF at younger (25.6%) or older (19.7%) ages, which is significantly higher than for Whites (7.7% and 15.75% respectively). Similar results were observed for other risk thresholds and for the 1960 cohort. Further consideration is needed to incorporate comprehensive risk factors, including race/ethnicity, into lung screening criteria to reduce potential racial disparities.