According to a study examining cross-sectional data from 20 states that was published in the journal Radiology, racial and ethnic disparities in lung cancer screening endure, even with revised eligibility guidelines from the U.S. Preventative Services Task Force (USPSTF).
In 2014, the USPSTF recommended lung cancer screening (LCS) with low-dose chest computed tomography in high-risk patients to decrease cancer-related mortality. The initial eligibility guidelines had limitations, as they were derived from studies in which only 4% of participants were African American smokers.
In March 2021, the task force expanded eligibility, lowering the threshold for LCS eligibility from age 55 years to age 50 years and from at least 30 to at least 20 pack-years of smoking. (Pack-years is the number of packs smoked per day multiplied by the number of years smoking.) The goal of the revised USPSTF recommendations were to address disparities that may exclude large numbers of high-risk African American smokers. Since there is limited recent data about the impact of newly revised guidelines on disparities in LCS eligibility, researchers Anand K. Narayan, MD, PhD, et al examined the impact of the newly revised USPSTF 2021 guidelines on racial and ethnic disparities in LCS eligibility.
The researchers utilized retrospectively evaluated cross-sectional data from the 2019 Behavioral Risk Factor Surveillance System survey (median response rate, 49.4%) and included more than 77,000 respondents. Respondents without a history of lung cancer aged 55 to 79 years (i.e., under the previous guidelines) or aged 50 to 79 years (i.e., under the revised guidelines) were included.
Multivariable logistic regression analyses were performed to evaluate the association between race and ethnicity and LCS eligibility, and all analyses accounted for complex survey design features (i.e., weighting, stratification, and clustering).
The researchers discovered that for the previous USPSTF guidelines, 11% of 67,567 weighted survey respondents were eligible for LCS (white [12%], Hispanic [4%], African American [7%], American Indian [17%], Asian or Pacific Islander [4%], and other [12%]). They also noted that under the revised USPSTF guidelines, 14% of 77,689 weighted survey respondents were eligible for LCS (white [15%], Hispanic [5%], African American [9%], American Indian [21%), Asian or Pacific Islander [5%], and other [18%]).
The authors noted that compared with white respondents, African American respondents (adjusted odds ratio [OR] = 0.36; 95% CI: 0.27, 0.47; P <.001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.09, 0.24; P <.001) were less likely to be eligible for LCS under previous guidelines. Under the revised guidelines, the researchers found that African American respondents (adjusted OR = 0.39; 95% CI: 0.32, 0.47; P <.001) and Hispanic respondents (adjusted OR = 0.15; 95% CI: 0.10, 0.23; P <.001) were less likely to be eligible.
The authors noted that their study had limitations. First, the results were limited by reliance on self-reported survey responses to determine eligibility for LCS, a method that could underestimate current smoking rates. Second, by using cross-sectional survey data, the study was also limited by a lack of follow-up to determine if survey respondents developed lung cancer.
The researchers concluded that neither the previous nor the revised USPSTF LCS guidelines include significant risk factors of race and ethnicity and socioeconomic status. Additionally, African American and Hispanic smokers become eligible for LCS when their risk of lung cancer is higher than that of whites, thus perpetuating inequities in healthcare access and thwarting early intervention in these high-risk groups.
Dr. Narayan stated, "If we put social determinants of health into our model, then we can more accurately reflect risk. It can give us tools to direct our resources toward patients in terms of how much risk they are experiencing and how much care they actually need. We can then target high-risk patients for more intensive screening and diagnostic services."
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