A recent assessment of the impact of the 2020 United States Preventive Service Task Force (USPSTF) lung-cancer screening guidelines, relative to 2013 USPSTF guidelines, indicated a lack of improvement over time in the relative racial/ethnic disparity among patients eligible for screening, with a possible worsening of existing disparities. Results of this assessment were published in the Journal of the National Cancer Institute.1

“The current study answers some questions but raises others about the promise of lung cancer screening to reduce disparities,” Stacey Fedewa, PhD, and Gerard A. Silvestri, MD, explained in an editorial accompanying the report.2

Based on an awareness that the rate of cigarette smoking and the age at diagnosis tend to be lower in the Black population, the 2020 USPSTF guidelines expanded lung-cancer screening eligibility to include younger patients and lower pack-year thresholds.2 This led to expanded screening eligibility estimated to include 6.5 million additional people, and expanded eligibility did appear to result in greater numbers of eligible patients from all racial or ethnic groups.1


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However, this expansion of eligibility did not improve racial/ethnic disparities because the proportions of newly eligible persons remained fairly similar to the proportions existing prior to this change, with some increases in potential benefits gained for the White population relative to other groups.1

The researchers next examined the impact of modifying screening eligibility based on an individualized, risk-based predictive model. Compared with disparities using 2020 USPSTF guidelines, when eligibility incorporated this predictive model, the African American/White disparity for preventable lung-cancer deaths dropped to approximately 0% from 13%, and the disparity for life-years gained dropped to approximately 1% from 16%. Screening efficiency improved for Asian American and Hispanic American populations when using this modeling method.1

“Guidelines based purely on age, pack-years, and quit-years cannot eliminate disparities in preventable deaths or gainable life-years. Given only those 3 factors, it is not possible to identify individuals in whom the same proportion of lung cancer deaths are prevented across each race/ethnicity,” concluded the researchers in their report.1

Disclosures: One author has declared affiliation with or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

References

  1. Landy R, Young CD, Skarzynski M, et al. Using prediction-models to reduce persistent racial/ethnic disparities in draft 2020 USPSTF lung-cancer screening guidelines. J Natl Cancer Inst. Published online January 5, 2021. doi:10.1093/jnci/djaa211
  2. Fedewa S, Silvestri GA. Reducing disparities in lung cancer screening: it’s not so black and white. J Natl Cancer Inst. Published online January 5, 2021. doi:10.1093/jnci/djaa212