Lung Cancer Screening Guidelines to Reduce Disparities May Increase Them Instead—But Risk Model Can Help
The draft 2020 U.S. Preventive Services Task Force (USPSTF) lung cancer screening recommendations were intended to increase the number of high-risk minorities eligible for lifesaving tests. And they do, but not as much as USPSTF anticipated, still leaving gaps and disparities, researchers reported (https://doi.org/10.1093/jnci/djaa211) in the Journal of the National Cancer Institute. They created a risk model to augment the guidelines that eliminated the disparities for most racial groups.
Using data from the 2015 National Health Interview Survey, the researchers compared the 2020 draft guidelines to the 2013 published version to measure the changes in eligibility for all groups. They found that although eligibility increased, the racial gap between Whites and minorities did too: by 15%–16% for African Americans, 12.7%–19.3% for Asian Americans, and 23.5%–27.5% for Hispanic Americans.
However, the researchers found that using the Life-Years From Screening With Computed Tomography model nearly eliminated disparities for African Americans, reducing them to just 1.2%, and improved screening efficiency for Asian and Hispanic Americans, although the disparities reduced only slightly for Hispanic Americans and did not change for Asian Americans.
“Guidelines based purely on age, pack-years, and quit-years cannot eliminate disparities in preventable deaths or gainable life-years,” the researchers said (https://doi.org/10.1093/jnci/djaa211). “The use of prediction models could potentially reduce disparities, as demonstrated here, depending on the performance of the model and the threshold selected. Unlike individualized risk, individualized life-gained explicitly quantifies into a single metric several implicit considerations: disease risk, life expectancy, comorbidity and performance status, and the probability of benefits and harms from screening.”