Proposed Revisions To Lung-Cancer-Screening Eligibility Criteria May Not Go Far Enough

Revised draft guidelines on lung-cancer screening from the U.S. Preventive Services Task Force (USPSTF) may increase rates of lung-cancer screening for women and Black and Hispanic populations, although inequities in screening may persist without tailored eligibility criteria, say the authors of a new study.

Since 2013, the USPSTF has advised low-dose CT for people who are current smokers or who quit within 15 years, are between age 55 and 80 years old, and have a smoking history of more than 30 pack-years

These criteria were based in part on the 2004 National Lung Screening Trial, in which more than 53,000 high-risk patients were randomly assigned to low-dose CT or chest radiography, with the low-dose-CT group having a 20% relative reduction in lung cancer mortality. But the trial mostly enrolled white men and under-represented women and Black/Hispanic populations.

To reflect current evidence, the USPSTF has drafted revised guidelines for lung-cancer-screening eligibility criteria by lowering the age to 50 years and reducing the smoking history to 20 pack-years.

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To gauge the impact of these proposed changes, Dr. Thomas Reese and colleagues at the University of Utah, in Salt Lake City, did a cross-sectional study of the roughly 40,000 respondents to the Behavioral Risk Factor Surveillance System for 2017 and 2018.

Respondents to the federal survey were between 50 and 80 years old with a smoking history, 52% were women, 8% were Black, and 30% were Hispanic.

In comparing the revised lung cancer screening eligibility criteria with the original criteria, the proportion of men who were eligible significantly increased from 29% to 38% and the proportion of women who were eligible increased from 26% to 36%.

In racial/ethnic populations, the revised criteria increased eligibility for whites (31% to 41%); Blacks (16% to 29%); and Hispanics (11% to 19%).

The likelihood of being screen-eligible was lower for women than men (adjusted odds ratio, 0.88; P=0.04) and for Black (AOR, 0.43; P<0.001) and Hispanic populations (AOR, 0.70; P<0.001) compared with the white population.

These findings suggest that Black and Hispanic smokers are "likely to continue to be underrepresented among individuals eligible for lung-cancer screening, despite data suggesting that their risk of lung cancer is equivalent to or greater than that of white smokers," Dr. Reese and colleagues write in JAMA Network Open.

They say "simply raising or lowering the criteria based on age and smoking history are unlikely to have a meaningful effect on reducing inequities across racial/ethnic groups, and lung cancer screening criteria are likely to remain biased against Black and Hispanic smokers unless the criteria are adapted for different racial/ethnic groups."

Dr. Reese did not respond to a request for comment by press time.

USPSTF member Dr. Michael Barry, clinician and director of the informed medical decisions program in the Health Decision Sciences Center at Massachusetts General Hospital and professor of medicine at Harvard Medical School, said, "The Task Force is committed to doing what it can to reduce health disparities and is particularly concerned about the disparities that persist around the number of women and members of specific racial and ethnic groups that get and die from lung cancer. Fundamentally, not enough people who are eligible get screened for lung cancer, and increasing implementation is one of the biggest things that would help save lives from this terrible disease."

"When the Task Force makes a recommendation, we use all of the evidence that's available to do what we can to help improve the health of diverse populations," he told Reuters Health by email. "We are calling for additional research on lung-cancer screening in women and specific racial and ethnic groups in order to help even more people live longer, healthier lives."

The revised guidelines remain in draft form. The Task Force is currently reviewing the public comments that it received on the draft and will publish a final recommendation statement when that work has been completed.

—Megan Brooks

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