Low-dose computed tomography (CT) for lung cancer screening has been shown to reduce lung cancer-specific mortality by over 20%, prompting the US Preventive Services Task Force (USPSTF) to issue guidelines for annual screenings. The 2021 update to these guidelines lowered the starting age to 50 and cumulative smoking exposure to 20 pack-years, aiming to reduce disparities in screening eligibility between Black and White individuals. However, disparities among other racial and ethnic groups remain under-examined[1].
Eunji Choi, PhD, and colleagues investigated the performance of the Prostate, Lung, Colorectal, and Ovarian Screening Trial 2012 (PLCOm2012) model across five racial and ethnic groups in the United States. Their findings, published in JAMA Oncology, suggest that risk model-based screening could improve screening performance and further reduce racial and ethnic disparities[1].
The study utilized data from the Multiethnic Cohort Study, which included adults aged 45 to 75 years with a history of smoking. The cohort was diverse, comprising Black, Japanese American, Latino, Native Hawaiian/Other Pacific Islander, and White individuals. The researchers found that under the 2021 USPSTF guidelines, 24% of participants would have been eligible for screening, with significant disparities among racial and ethnic groups. For instance, 30.2% of White individuals were eligible compared to only 15.7% of Latino individuals[1].
Using the PLCOm2012-Update model, the eligibility-incidence (E-I) ratio disparities were substantially reduced, particularly between Black and White participants. The model also showed higher overall sensitivity and a lower number needed to screen at similar specificity compared to the USPSTF 2021 criteria[1].
The study’s limitations include the cohort’s geographic concentration in California and Hawaii, which may not reflect the entire US population. Additionally, the efficacy of screening in reducing lung cancer mortality across different racial and ethnic groups is still unknown.
In summary, Choi and colleagues advocate for risk-based lung cancer screening using validated risk prediction models to help reduce racial and ethnic disparities and improve screening efficiency in the United States.
See “Lung Cancer Screening Guidelines Yield Racial, Ethnic Disparities” by Eileen Koutnik-Fotopoulos on the DocWireNews website (January 26, 2024)
