The US Preventative Services Task Force’s (USPSTF’s) updated criteria for lung cancer screening eligibility has been projected to improve lung cancer screening rates for women and Black and Hispanic populations, but these groups’ eligibility was still found to be lower than that of men and White individuals, according to the results of a study published in JAMA Network Open.1
The original USPSTF Lung Cancer Screening Guideline was based on the number of individuals deemed high-risk for developing lung cancer from the 2004 National Lung Screening Trial. Because some populations were underrepresented in this trial, the eligibility criteria in the USPSTF guideline might have led to disparities in screening.
In 2020, the USPSTF guideline was revised to address this. The updated guideline presently supports lung cancer screening for patients aged 50 years with a 20 pack-year smoking history. In the prior guideline (2013), the USPSTF recommended that adults aged 55 to 80 years with a 30 pack-year smoking history who either were active smokers or quit within the past 15 years pursue yearly screening with low-dose computed tomography.
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“Research is needed to investigate how the revised eligibility criteria affect minority and vulnerable populations,” the study authors wrote.
The study analyzed data from 40,869 individuals aged 50 to 80 years who participated in the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS) survey from 2017 to 2018. The BRFSS is a nationwide yearly telephone survey that aggregates health and wellness data to inform research, practices, and policy. Eligibility for the study was based on smoking history.
Although the revised USPSTF lung cancer screening criteria resulted in an increase in screening eligibility among all populations evaluated in the study, “despite these potential improvements, eligibility disparities may persist,” the study authors noted.
Of the racial/ethnic populations evaluated, the White population had the highest proportion of individuals eligible for screening, which increased from 31.1% to 40.9% under the new criteria. Men saw the second largest increase (29.4% to 38.3%).
Although the proportion of individuals from other populations who were eligible for screening also increased, the numbers remained lower than they did for White individuals and men specifically. For example, the proportion of women who were eligible for screening increased from 25.9% to 36.4%, the proportion of Black individuals, from 16.3% to 28.8%, and the proportion of Hispanic individuals, from 10.5% to 18.7%.
In a multivariate analysis, the odds of eligibility were found to be significantly lower for women vs men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P =.04). Further, the odds of eligibility for Black individuals (AOR, 0.43; 95% CI, 0.33-0.56; P <.001), and Hispanic individuals (AOR, 0.70; 95% CI, 0.62-0.80; P <.001) were lower than those for White individuals.
“These findings suggest that female, Black, and Hispanic populations remain less likely to be eligible for lung cancer screening with the revised USPSTF guidelines,” the study authors concluded. They added, “eligibility criteria may need to be tailored for women and racial and ethnic minority populations to reduce inequities.”
Disclosures: Some of the study authors disclosed financial relationships with the pharmaceutical industry and/or the medical device industry. For a full list of disclosures, please refer to the original study.
Reference
Reese TJ, Schlechter CR, Potter LN, et al. Evaluation of revised US Preventive Services Task Force Lung Cancer Screening Guideline among women and racial/ethnic minority populations. JAMA Netw Open. 2021;4(1):e2033769. doi:10.1001/jamanetworkopen.2020.33769
