National Lung Cancer Screening Guidelines Insufficient for Minorities, Study Finds

Researchers recently evaluated data collected from a lung cancer screening program at the University of Illinois at Chicago (UIC). The program provided evidence that the national lung cancer screening guidelines, which were developed based on the National Lung Screening Trial (NLST) in 2011, and recommend screening based on age and smoking history of individuals, may be insufficient for individuals in underrepresented communities.

The results, recently published in JAMA Oncology, found that when compared with patients in the NLST, the patients enrolled in the UIC screening program had a higher percentage of black (69.6% versus 4.5%) and Latino (10.6% versus 1.8%) individuals, respectively. In addition, the UIC program also had double the number of positive scans (24.6% versus 13.7%) and a higher percentage of diagnosed lung cancer cases (2.6% versus 1.1%).

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“Immunotherapies and other advances in medicine have come a long way in extending life and improving the quality of life for many individuals diagnosed with lung cancer, but those advances mean much less for people living in underserved communities who can’t access or are ineligible for screening programs,” said senior author, Lawrence Feldman, MD, in a statement.

According to the American Lung Association (ALA), African-Americans not only have a higher incidence of lung cancer, but they also have a higher mortality rate. For example, the age-adjusted lung cancer incidence rate among black men is about 30% higher compared with white men, despite having lower overall exposure to cigarette smoke. Additionally, the lung cancer incidence rate for black women is roughly equal to that of white women, even though they smoke fewer cigarettes, according to the ALA.

“Screening that is offered based only on age and smoking history may miss a large group of people who are at risk due to other factors,” commented Feldman.

The cohort of patients studied by researchers at UIC were made up of 500 men and women whose mean age was 62 years and had received care at the UIC Hospital and Clinics or UI Health Mile Square Health Center.

Although lung cancer screening is effective, these data show that the guidelines should incorporate more expansive, risk-based screening in order to address racial disparities in lung cancer outcomes, said Mary Pasquinelli, UIC nurse practitioner and lead study author.

Reference

Pasquinelli M, Kovitz K, Koshy M, et al. Outcomes from a minority-based lung cancer screening program vs the national lung screening trial [published online August 2, 2018]. JAMA Oncol. doi:10.1001/jamaoncol.2018.2823.