Revisiting the lung cancer screening eligibility criteria to promote equity for Black individuals

• Published in: Lung cancer (Amsterdam, Netherlands) Vol. 191; p. 107539
• Main Authors: Gudina, Abdi T., Kamen, Charles, Hardy, Sara J., Kehoe, Lee, Culakova, Eva, Cupertino, Ana-Paula
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2024
• Subjects: Adult; Aged; Behavioral Risk Factor Surveillance System; Black or African American - statistics & numerical data; Early Detection of Cancer - methods; Eligibility criteria; Eligibility Determination - methods; Female; Healthcare Disparities; Humans; Low-dose computed tomography; Lung cancer screening; Lung Neoplasms - diagnosis; Lung Neoplasms - epidemiology; Male; Middle Aged; Tailored criteria; Tomography, X-Ray Computed - methods; United States - epidemiology; USPSTF; White; White People - statistics & numerical data; United States; USPSTF; Eligibility criteria; Tailored criteria; Lung cancer screening; Low-dose computed tomography
• ISSN: 0169-5002; 1872-8332; 1872-8332
• DOI: 10.1016/j.lungcan.2024.107539

•The updated guideline increased the proportion of eligible individuals for LCS.•Under both guidelines, Blacks are significantly less likely to be eligible for LCS.•We proposed tailored LCS criteria for Blacks at age 43 years and ≥15 pack-years.•The tailored criteria would eliminate the disparities in LCS eligibility. Early detection using low-dose computed tomography reduces lung-cancer-specific mortality by 20% among high-risk individuals. Blacks are less likely than Whites to meet lung cancer screening (LCS) criteria under both the former and the updated United States Preventive Services Task Force (USPSTF) guidelines. The purpose of this study was to assess racial disparities in LCS eligibility and to propose tailored eligibility criteria for Blacks to enable equitable screening rate between Whites and Blacks. Data for this study were obtained from the Behavioral Risk Factor Surveillance System (2017–2021). 101,552 subjects were included in the final analysis. By employing a systematic approach, we sought cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. We evaluated the minimum age and smoking pack-years for Blacks while we retained the 2021 USPSTF criteria for Whites. The final decision was based on the minimum Wald’s Chi-square statistics. The model we employed identified cut-off points at which Blacks were equally likely as Whites to be eligible for LCS. Retaining the 2021 USPSTF criteria for Whites, the model discovered a new pair of points for Blacks by reducing the minimum age to 43 years and decreasing the cumulative number of cigarettes smoked to 15 pack-years. Based on these cut-off points, we created tailored criteria for Blacks. Under the tailored criteria, Blacks (OR: 1.00; 95 %CI: 0.88–1.14) had the same odds of eligibility for LCS as Whites. The odds of eligibility for LCS by sex under the tailored criteria did not differ significantly for Black men (OR: 1.02; 95 %CI: 0.85–1.24) and Black women (OR: 0.95; 95 %CI: 0.81–1.12) compared to their respective White counterparts. These tailored criteria for Blacks eliminate the disparities between Blacks and Whites in LCS eligibility. Future studies should test the sensitivity and specificity of these tailored criteria.