Lung Cancer Screening Criteria Miss Young, High-Risk Black Smokers

The current US Preventive Services Task Force lung cancer screening recommendations may be failing young, Black smokers, an abstract presented at CHEST 2020 suggests. The findings highlight racial disparities across medicine, and the authors consider more individual risk-based low-dose computed tomography (LDCT) screening guidelines to be a possible solution.

Screenings are a crucial step in catching cancer in its early stages and have been shown to lower cancer mortality. Since lung cancer is the deadliest type of cancer worldwide, much focus has been placed on improving lung cancer screening, including analyzing the USPSTF guidelines’ inclusivity. Researchers aimed to find out if the general screening guidelines are sufficient in communities with many young, Black smokers.

“The objective of our study is to investigate the need to modify the current screening guidelines practiced at our institution [LSU Health Sciences Center Shreveport] by assessing the applicability of newer individual risk-based prediction models for LDCT screening,” study authors wrote.

The retrospective, observational cohort study included a total of 980 patients 18 years of age or older who were newly diagnosed with lung cancer at LSU Health Sciences Center Shreveport from 2011 to 2015. Of those patients, 1/3 did not meet the current USPSTF lung cancer screening criteria (adults aged 55-80 who have a 30 pack-year smoking history and currently smoke, or have quit within the past 15 years).

Those patients were split into groups based on the 2018 NCCN Lung Cancer Screening Guidelines Version 1.2020: high risk (groups 1 and 2), moderate risk, and low risk. Then, the Tammemagi lung cancer risk calculator was used to differentiate between the high-risk group 2 (50 years of age or older, 20 or more pack years of smoking, other risk factors [other than second-hand smoke]) and the moderate-risk group (50 years of age or older, 20 or more pack years of smoking, no other risk factors).

Those with a ≥1.3% 6-year lung cancer risk probability based on the Tammemagi risk calculator were considered to be part of high-risk group 2 and <1.3% as part of the moderate-risk group. The NCCN guidelines consider high-risk groups 1 and 2 as eligible for annual LDCT.

About 33% of lung cancer patients in the study were diagnosed at less than 55 years old and were therefore ineligible for yearly screenings based on the USPSTF guidelines. Close to 50% of patients in that group were African American, 95% of whom had a known smoking history. Of those patients, 80% were in advanced stages of cancer by the time they were diagnosed. Once the Tammemagi risk calculator was applied in those patents, 12.5% fell into high-risk group 2.

The study authors concluded that the USPSTF guidelines do not cater to the population of younger African American smokers at the LSU Health Sciences Center Shreveport, indicating a racial disparity in health care. They believe that age is a limiting factor in the USPSTF screenings and that using individual risk-based prediction models based on individual community demographics might help physicians determine high-risk populations more effectively.

“New screening methods must be implemented, focusing on smoking history and population demographics,” the authors wrote. Then, physicians can use appropriate LDCT screening to diagnose these cases earlier without screening lower risk populations unnecessarily.

Reference

Martinez CV, Thurlapati A, Hirani S, et al. Do our current USPSTF guidelines for lung cancer screening fail young, high-risk African American smokers? Presented at: CHEST 2020; October 18-21, 2020. Abstract A1454-A1455.