In a study reported in the Journal of Clinical Oncology, Potter et al found that use of a smoking history of ≥ 20 years rather than the current 2021 U.S. Preventive Services Task Force (USPSTF) guideline of ≥ 20 pack-years would increase the eligibility of Black individuals for lung cancer screening, as well as help to reduce the disparity between Black and White individuals in the percentage of cancer cases considered eligible for screening.
Study Details
The study used data from more than 49,000 individuals with a smoking history from the Southern Community Cohort Study (SCCS; 33,585 Black men and women, 16,118 White men and women) and more than 22,100 Black women with a smoking history from the Black Women’s Health Study (BWHS) to assess eligibility for screening under the current USPSTF guideline vs the proposed guideline of ≥ 20-year smoking duration.
Key Findings
The proportion of all SCCS participants (with or without lung cancer) who would have qualified for screening increased from 37.3% under the 2021 USPSTF guideline to 71.3% under the proposed guideline among Black participants (P < .001) and from 51.5% to 62.5% (P < .001) among White participants. Primary lung cancer was diagnosed over follow-up in 4.0% of Black participants and 5.0% of White participants.
Under the 2021 USPSTF guideline, 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, compared with 74.0% of White patients with lung cancer (P < .001). Under the proposed guideline, the percentage of Black patients with lung cancer who would have qualified for screening increased to 85.3%, and the percentage of White patients with lung cancer who would have qualified for screening increased to 82.0%.
The proportion of BWHS participants (with or without lung cancer) who would have qualified for screening increased from 13.9% with the 2021 USPSTF guideline to 29.1% with the proposed guideline (P < .001).
Over follow-up, primary lung cancer was diagnosed in 2.2% of women. Use of the proposed criterion would have increased the proportion of women with lung cancer who would have qualified for screening to 63.8% from 42.5% according to the 2021 USPSTF criterion (P < .001).
The investigators concluded: “Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black vs White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history.”
Chi-Fu Jeffrey Yang, MD, of the Division of Thoracic Surgery, Massachusetts General Hospital, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the National Cancer Institute and others. For full disclosures of the study authors, visit ascopubs.org.
