New lung cancer guidelines reduced some screening disparities

New lung cancer screening guidance from the U.S. Preventive Services Task Force, which lowered the age for inclusion and intensity of smoking to qualify as high risk, resulted in an increase in the proportion of Black individuals screened.

In the first 9 months after implementation of the new USPSTF guidelines, which were released in 2021, 54% of individuals eligible for screening by the new criteria were Black, whereas only 39% were Black in the group that were eligible for screening using the 2013 criteria, according to a research letter published in JAMA Network Open.

The criteria published in 2013 defined those at high risk for lung cancer as individuals aged 55 to 80 years who are in good health, have at least a 30 pack-year smoking history and currently smoke or quit within the past 15 years. These guidelines excluded Black individuals, who are often diagnosed with late-stage lung cancer in early life. In 2021, those recommendations were expanded to include individuals aged 50 to 80 years and lowered the pack-year history to 20, according to a press release from Thomas Jefferson University.

“Without screening, lung cancer is often discovered in late stages of the disease, when treatments are considerably less effective,” Julie A. Barta, MD, assistant professor of medicine and co-lead of the Lung Cancer, Screening and Nodules Program at the Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, said in the press release. “Our goal was to test whether the new guidelines were effective at reducing disparate screening uptake in African Americans.”

The researchers conducted a cross-sectional study of 815 individuals who completed lung cancer screening from March and December 2021 at Thomas Jefferson University. Researchers split individuals into a 2013 USPSTF-eligible cohort (n = 654; mean age, 64.9 years; 56.4% women) and a 2021 USPSTF-eligible cohort (n = 161; mean age, 59 years; 60.2% women).

A greater proportion of individuals eligible eligible for lung cancer screening according to the 2021 guidelines were Black compared with the 2013 guidelines (54% vs. 39%; P = .002).

In addition, the newly eligible individuals more frequently reported current smoking (65.2% vs. 55%), had a lower frequency of Medicare insurance (17.4% vs. 39.6%) and significantly lower mean lung cancer risk according to the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial modified in 2012 (mean, 4.4 vs. 6.37), according to the results.

The researchers found no difference in screening rates by sex, distribution of educational attainment or Lung Imaging Reporting and Data System (Lung-RADS) results under the 2021 criteria compared with the 2013 criteria.

“While it is encouraging to see a larger cohort of African American patients getting screened thanks to the new guidelines, we are well aware that changing guidelines is only a first step to improving screening uptake and reducing cancer disparities,” Barta said in the release. “For many, significant barriers persist long before a patient ever enters the exam room, such as lack of transportation, limited clinic hours, as well as attitudes and beliefs surrounding health care and smoking.”

The researchers plan to continue working to expand availability, increase knowledge on lung cancer screening and implement community-based outreach approaches to continue addressing these disparities, according to the release.

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