The U.S. Preventive Services Task Force (USPSTF) may make recommendations to revise current lung cancer screening guidelines to reduce large differences between outcomes of African American and white patients.
The decision will rest in part on research led by Melinda Aldrich, Ph.D., an associate professor of medicine at Vanderbilt University Medical Center. The research team included Kim Sandler, M.D., an assistant professor of radiology and radiological sciences and co-director of the Vanderbilt Lung Screening Program.
Said Aldrich, “Overall, our goal is to equalize the performance of lung cancer screening for African American smokers and narrow the gap in health disparities between them and other groups. Screening guidelines should be equitable.”
“Our goal is to equalize the performance of lung cancer screening for African American smokers and narrow the gap in health disparities.”
Smoking Risks Vary Among Racial Groups
Current guidelines recommend CT screening for smokers age 55 to 80 with a 30 pack-year history who still smoke – or have quit only within the past 15 years. Research done by the Vanderbilt team published in JAMA Oncology revealed that only 32 percent of African American patients with lung cancer currently qualified for screening versus 56 percent of white patients.
The Vanderbilt study highlighted specific smoking patterns and how they influenced screening eligibility.
“African American smokers tend to smoke fewer cigarettes overall as compared to white smokers, but their lung cancer risk remains high. The current guidelines don’t address this discrepancy,” Aldrich said.
“African American smokers tend to smoke fewer cigarettes overall as compared to white smokers, but their lung cancer risk remains high. The current guidelines don’t address this discrepancy.”
Uncovering Multiple Disparities
In total, the researchers analyzed data from 48,364 “ever-smokers” enrolled in the Southern Community Cohort Study, among whom 1,269 patients developed lung cancer. African American smokers comprised 67 percent of the overall cohort. The study was one of the largest evaluations ever done of the USPSTF lung cancer screening guidelines in African American smokers.
The researchers collected demographic information alongside data on smoking habits and history. Nearly half of African Americans diagnosed with lung cancer did not meet the minimum 30 pack-year requirement for screening, while only 16 percent of white lung cancer patients failed to reach that minimum. The authors noted that for African American smokers, adjusting the requirement from 30 to 20 pack-years would increase the number of those eligible for screening from 17.4 to 28.5 percent.
Across both racial groups, large proportions of smokers who later developed lung cancer did not meet age requirements for screening (24 percent of African American patients; 19 percent of white patients). Thus, lowering the age requirement could have widespread benefits – particularly for African Americans who often develop lung cancer at an earlier age than other groups.
Steps to Expand Screening
Revising the USPSTF guidelines could be a key step to improving lung cancer screening access for African American smokers, since the guidelines inform how insurance companies determine CT scan coverage. Screening for the disease has been insufficient, especially compared to levels of screening for breast and colorectal cancer.
Sandler and Aldrich note that reluctance is another significant barrier to lung screening among patients of all racial and ethnic groups. “There’s a lot of stigma with lung cancer screening,” Sandler said. “Patients feel responsible for the exposure.”
“There’s a lot of stigma with lung cancer screening. Patients feel responsible for the exposure.”
Added Aldrich, “Of course, there is also the issue of self-reported race which is a social construct and thus has challenges with its use.”
The researchers say they try to mitigate stigma and maintain screening equity by being matter-of-fact, reminding their patients that they qualify for this life-saving exam.