Basing lung cancer screening eligibility decisions on pack-year history misses about 27% of Black patients and 8% of White patients who should otherwise qualify for screening, researchers reported in study findings published in the Journal of Clinical Oncology. They found that total smoking duration history was a more accurate indicator of individuals who should be offered lung cancer screening.
The current U.S. Preventive Services Task Force (USPSTF) lung cancer screening guidelines recommend using a 20-year pack-history to identify individuals with a higher risk for the disease. For their study, researchers evaluated whether using a simple 20-year smoking duration would more accurately identify individuals, particularly those from diverse racial and ethnic groups.
Using data from 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS), the researchers compared the number of screening-appropriate candidates identified through the USPSTF guideline criterion versus the proposed simple 20-year smoking duration.
Under the USPSTF guideline, they found that only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening compared to 74.0% White patients. However, when using their proposed criterion, the percentage of eligible Black and White patients with lung cancer increased to 85.3% and 82.0%, respectively, “eradicating the disparity in screening eligibility between the groups,” the researchers said. “Notably, nearly 100% of Black and White individuals in the SCCS age 50–59 years with lung cancer would have qualified for screening under the proposed guideline.” They found a similar increase when applying the two criterion to patients in the BWHS, where the percentage of Black women with lung cancer who would have qualified for screening increased from 42.5% with the USPSTF method to 63.8% with the smoking duration method.
In addition to being a more precise measurement and accurate prediction tool, the researchers said that using their proposed criterion would be simpler to implement in USPSTF’s guideline than some of the more complex proposed risk prediction models. Barriers already exist with lung cancer screening—with less than 5% of eligible patients undergoing screening—and use of risk prediction models could widen the gap, the researchers said.
“These data suggest that revising the USPSTF criteria to include a 20-year smoking duration cutoff instead of a 20-pack-year cutoff would be an important step forward to eliminate racial disparities in lung cancer screening eligibility and would contribute to the advancement of ongoing efforts by the USPSTF to address systemic racism in preventive service recommendations,” the researchers concluded.
August 1 is World Lung Cancer Day. Learn more about racial disparities in lung cancer with ONS’s four-part case study.