Expanded lung cancer screening eligibility criteria could benefit women, Black individuals
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Key findings:
- Modifications to lung cancer screening criteria could significantly increase the proportion of eligible women and Black individuals.
- The percentage of screening-eligible individuals with lung cancer increased from 22% under 2013 criteria to 37% under expanded criteria that would lengthen smoking quit duration and reduce smoking pack-years.
An expansion of lung cancer screening criteria to include those who are younger and with less smoking exposure would increase eligibility for women and Black individuals who could benefit, results of a retrospective study showed.
The findings — published in Journal of Thoracic Oncology — revealed that approximately one-third of those who developed lung cancer would have been eligible for yearly low-dose CT screening at a younger age if criteria included those who have smoked fewer years or have a longer duration since they quit smoking.
“Our current criteria are not nearly good enough,” Raymond U. Osarogiagbon, MBBS, FACP, chief scientist at Baptist Memorial Health Care and director of the multidisciplinary thoracic oncology program and thoracic oncology research group at Baptist Cancer Center in Memphis, told Healio. “These guidelines intensify sex- and race-based health care disparities and can be tweaked in such a way that they will not cost much extra for testing.”
Background
The U.S. Preventive Services Task Force (USPSTF) updated its recommendations in 2021 for once-yearly low-dose CT screening to include those aged 50 to 80 years who have a history of smoking — denoted as a 20 pack-year history — are active smokers or quit within the last 15 years.
The expanded criteria compared with 2013 recommendations aimed to include younger individuals with less previous exposure to smoking. The prior recommendations “underestimated the unique risks” facing women and racial minorities, according to Osarogiagbon, who is leading the effort to lower the USPSTF screening criteria age from 55 years to 50 years and the smoking intensity requirement from 30 pack-years to 20 pack-years.
“In theory, this should have opened screening up to more women and more Black people who are at high risk. But we know those criteria are still not good enough because [they] still miss more than 50% of people who will get lung cancer in America who would not qualify to be screened,” he said. “There's an ongoing need to figure out where the sweet spot is.”
Methodology
Osarogiagbon and colleagues conducted a retrospective analysis of 17,421 individuals (56% women; 69% white, 28% Black) using data collected from a lung nodule program within the Baptist Memorial Health Care system, serving an area in the U.S. Southeast that has “the highest U.S. per-capita lung cancer incidence and mortality rates and a high proportion of Black persons,” Osarogiagbon and colleagues wrote.
Researchers divided patients into groups eligible for low-dose CT screening based on increasingly expanded criteria, using the USPSTF 2013 criteria (aged 55-80 years, 30 pack-years of smoking and 15 years since smoking cessation) as the reference group.
Comparison groups included USPSTF 2021 criteria (aged 50-80 years, 20 pack-years of smoking and 15 years since smoking cessation), smoking cessation duration expanded to 25 years or less (USPSTF2021-QD25), reducing the pack-years of smoking to 10 or more years (USPSTF2021-PY10), and both longer cessation and reduced pack-years (USPSTF2021-QD25-PY10).
Key findings
Investigators found that 13% of patients in the study sample met USPSTF2013 criteria for yearly low-dose CT screening for lung cancer. This proportion increased to 17% using USPSTF2021 criteria, 18% using USPSTF2021-QD25, 19% using USPSTF2021-PY10 and 21% using USPSTF2021-QD25-PY10.
Use of USPSTF2021 criteria led to a significant 27% increase in the number of Black patients eligible for low-dose CT screening. Likewise, significantly more Black patients (29%) became eligible for low-dose CT screening when applying USPSTF2021-QD25-PY10 criteria.
Women comprised 55% of the additional patients eligible for screening using USPSTF2021 and USPSTF2021-QD25-PY10 criteria.
The investigators identified 1,243 patients (7.1%) in the nodule program as having lung cancer, 22% of whom were eligible for yearly low-dose CT screening according to USPSTF13 recommendations. This increased to 37% when applying USPSTF2021-QD25-PY10 criteria, they noted.
Clinical implications
Lowering the criteria for age and smoking exposure can help identify a large number of additional lung cancer cases through low-dose CT screening and catch disease at earlier stages, according to Osarogiagbon.
This is especially true for women, who tend to acquire lung cancer at a younger age and with less exposure to smoking.
He hopes the results will provide the USPSTF with data to consider when it contemplates its next round of revisions to recommendations, so that criteria are broadened to include more of these patients.
“The criteria as currently set are sort of stacked against women to qualify for screening,” he told Healio.
For more information:
Raymond U. Osarogiagbon, MBBS, FACP, can be reached at Thoracic Oncology Research Group, Baptist Cancer Center, 80 Humphreys Center Drive, Suite 330, Memphis, TN 38120; email: rosarogi@bmhcc.org; Twitter: @ROsarogiagbon.
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