Revised criteria may ‘substantially reduce racial disparities’ in lung cancer screening

Key takeaways:

• An alternative LCS criteria had higher sensitivity and specificity vs. the USPSTF’s current criteria.
• The analysis also revealed significant inequities within the task force’s criteria.

Alternative lung cancer screening criteria may identify more individuals, who would benefit from screening compared with current guidelines, study results showed.

The findings — published in Annals of Internal Medicine — suggest the alternative criteria can also identify more individuals from historically underserved populations who would benefit from lung cancer screening.

The U.S. Preventative Services Task Force currently recommends lung cancer screening for patients aged 50 to 80 years with a minimum smoking history of 20 pack-years and who currently smoke or quit smoking within the past 15 years.

Yet, lung cancer screening rates remain low in the United States, according to Lauren E. Kearney, MD, an instructor of medicine at Boston University Chobanian and Avedisian School of Medicine, and colleagues. “Modeling studies suggest that the USPSTF criteria may not be optimally effective, efficient, or cost-effective because many people who would derive high benefit from [lung cancer screening] are ineligible,” they wrote.”

In the study, researchers used 1997 to 2014 National Health Interview Survey (NHIS) data, fast-and-frugal tree algorithms and information from the USPSTF’s criteria to develop alternative criteria aimed at better identifying those who would have “high benefit” from lung cancer screening, defined as gaining an average of at least 16.2 days of life from three annual screenings.

The final alternative lung cancer screening criteria included people who smoked any amount each year for at least 40 years or people aged 60 to 80 years with at least 40 pack-years of smoking.

Kearney and colleagues compared the alternative criteria with the task force’s criteria using 2014 to 2018 NHIS data and 2022 Behavioral Risk Factor Surveillance System data.

Overall, the alternative criteria had higher sensitivity (91% vs. 78%) and specificity (86% vs. 84%) for identifying high-benefit people vs. the USPSTF criteria.

Additionally, the alternative criteria had greater sensitivity among Black (83% vs. 56%), Hispanic (95% vs. 73%) and Asian individuals (94% vs. 68%) compared with the task force’s criteria, and similar sensitivity.

The researchers noted the study also highlighted inequities within the USPSTF’s criteria, particularly its poor sensitivity (60%) for identifying high-benefit Black individuals.

“Prior data suggest that this relates to Black people being more likely to be diagnosed with lung cancer with fewer pack-years of tobacco use, leading to disproportionate exclusion from [lung cancer screening],” they wrote.

Kearney and colleagues explained that the alternative criteria had a higher sensitivity vs. the USPSTF criteria because the algorithm identified smoking duration as an important variable and because it was a two-path algorithm, which can balance specificity and sensitivity better than one-path algorithms like the current screening criteria.

The criteria developed by the researchers “would result in more effective screening, lead to better support of the ethical principle of ‘equal management for equal risk’ and substantially reduce racial disparities,” they wrote.

They added that this approach to assessing selection strategies “may be useful for other cancer screening and prevention methods.”