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

Abdi T Gudina; Charles Kamen; Sara J Hardy; Lee Kehoe; Eva Culakova; Ana-Paula Cupertino

doi:10.1016/j.lungcan.2024.107539

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

Lung Cancer. 2024 Mar 20:191:107539. doi: 10.1016/j.lungcan.2024.107539. Online ahead of print.

Authors

Abdi T Gudina¹, Charles Kamen², Sara J Hardy³, Lee Kehoe², Eva Culakova², Ana-Paula Cupertino⁴

Affiliations

¹ Department of Public Health Sciences at the University of Rochester, School of Medicine and Dentistry, NY, United States. Electronic address: Abdi_Gudina@urmc.rochester.edu.
² Division of Supportive Care in Cancer in the Department of Surgery at the University of Rochester, School of Medicine and Dentistry and the James P. Wilmot Cancer Institute at the University of Rochester, School of Medicine and Dentistry, NY, United States.
³ Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States; Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States.
⁴ Surgical Health Outcomes and Reaching for Equity (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY, United States.

PMID: 38552545
DOI: 10.1016/j.lungcan.2024.107539

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Eligibility criteria; Low-dose computed tomography; Lung cancer screening; Tailored criteria; USPSTF.

Abstract

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