USPSTF Eligibility Criteria for Lung Cancer Screening May Be Missing a High Percentage of Younger African Americans at High Risk

The following article features coverage from the IASLC 2019 World Conference on Lung Cancer meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Results from an analysis incorporating additional risk factors for lung cancer beyond those on which the lung cancer screening guidelines from the United States Preventive Services Task Force (USPSTF) guidelines were based showed that a high percentage of younger African Americans at high risk of lung cancer would be missed using the USPSTF criteria only.¹ The findings from this poster were presented at the IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer held in Barcelona, Spain.

The USPSTF lung cancer screening guidelines recommend low-dose computed tomography (LDCT) screening for patients aged 55 to 80 years based on smoking history. These selection criteria do not differ according to race, and were based on a population that included very few African-American individuals.²

In this analysis, lifetime lung cancer risk was determined for 100,000 US men and women in the birth cohort covering the period from 1950 to 1960 using data from the National Health Interview Survey, the Cancer Intervention and Surveillance Modeling Network (CISNET) Smoking History Generator, and other models focused on nonsmoking risk factors for lung cancer.^3,4

Six-year risk of lung cancer for each individual in the birth cohort aged 45 to 90 years was determined through use of the 2012 version of the Prostate, Lung, Colorectal, and Ovarian risk-prediction model (PLCOm2012),⁵ and eligibility for lung cancer screening according to USPSTF criteria was also determined for each member of the birth cohort.

A key finding from the study showed that 6.73% and 13.97% of those born in 1950 who meet risk-based criteria for screening would not meet USPSTF criteria at younger and older ages, respectively.

Notably, this discrepancy was more pronounced in African Americans born in 1950, with 25.6% and 19.7% of high-risk individuals not meeting USPSTF screening criteria at younger and older ages, respectively. In comparison, 7.7% and 15.75% of white individuals at high risk for lung cancer would be missed using USPSTF criteria at younger and older ages, respectively. Results were similar for the 1960 birth cohort.

In their concluding remarks, the study authors noted that “further consideration is needed to incorporate comprehensive risk factors, including race/ethnicity, into lung screening criteria to reduce potential racial disparities.”

Read more of Cancer Therapy Advisor‘s coverage of the IASLC annual meeting by visiting the conference page.

References

1. Han SS, Chow E, Haaf T, et al. Disparities and national lung cancer screening guidelines in the U.S. population. Presented at: IASLC 2019 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer; September 7-10, 2019; Barcelona, Spain. Abstract P1.11-03.
2. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330-338.
3. Centers for Disease Control and Prevention. National Health Interview Study. https://www.cdc.gov/nchs/nhis/index.htm. Reviewed August 22, 2019. Accessed September 5, 2019.
4. National Cancer Institute. Cancer Intervention and Surveillance Modeling Network. https://resources.cisnet.cancer.gov/projects/. Accessed September 5, 2019.
5. Evidencio Medical Decision Support. Simplified PLCOm2012: Selection criteria for lung cancer screening. https://www.evidencio.com/models/show/993. Accessed September 5, 2019.