Calculated 6-year lung cancer risk lower in Black adults with screen-detected cancers
Click Here to Manage Email Alerts
Black adults with screen-detected cancers had a lower calculated 6-year lung cancer risk compared with white adults, despite a significantly higher mean lung cancer risk, according to new research.
“Black individuals tend to have a lesser smoking history and present with lung cancer at an earlier age; therefore, traditional eligibility guidelines for screening may miss a large number of Blacks at high risk for lung cancer. Individualized, risk-based calculations may be more cost-effective, accurate and decrease the number of high-risk patients that are currently deemed ineligible,” Christine S. Shusted, MPH, academic lung cancer screening data analyst at the Jane and Leonard Korman Respiratory Institute at the Sidney Kimmel Medical College at Thomas Jefferson University, and colleagues wrote in an e-poster presented at the American Thoracic Society Virtual meeting.
Researchers analyzed patients in the Jefferson Lung Cancer Screening Program, a centralized program at an urban academic medical center, who were screened from January 2018 to December 2019. Shusted and colleagues generated a 6-year lung cancer risk score for each patient. Overall, 1,036 patients were screened during this period (screening cohort). Of those, 978 self-identified as Black or white. Twenty patients were diagnosed with cancer during the follow-up period of 24 months (cancer cohort).
The researchers then used the validated Tammemagi model to calculate 6-year lung cancer risk scores for each patient. The researchers generated risk quartiles using median risk values for the screening cohort and the cancer cohort. The mean age of patients was 64 years and most were women. Black patients were more frequently former smokers with fewer pack-years of smoking compared with white patients.
Among Black patients with screen-detected lung cancer, 90% of cases were in women. The most common histology was adenocarcinoma in both Black and white patients. Three-quarters of cancers were stage I, II or limited-stage small cell lung cancer.
In the screening cohort, mean 6-year lung cancer risk score was higher among Black patients compared with white patients (7.78 vs. 5.91; P < .001). Sixty percent of Black patients had a risk score in Screening Cohort Risk Quartiles Q3 (4.808-8.685) and Q4 ( 8.686) compared with 42.3% of white patients. In the cancer cohort, mean 6-year lung cancer risk score was higher among white patients compared with Black patients (10.68 vs. 5.17; P = .011). Eighty percent of white patients had a risk scores in Cancer Cohort Risk Quartiles Q3 (7.454-12.443) and Q4 ( 12.444) compared with 20% of Black patients.
According to adjusted regression analysis, mean 6-year lung cancer risk scores were 2.377% higher among Black patients compared with white patients when the researchers controlled for individual risk factors such as age, sex, smoking status, BMI, personal and family cancer history (95% CI, 1.911-2.843; P < .001).
“This suggests that additional factors may influence lung cancer risk among blacks,” Shusted said during a prerecorded virtual presentation of the data. “Further research is needed to identify these factors and improve the accuracy of risk prediction among vulnerable populations.”