Current lung cancer screening guidelines miss many young, high-risk, Black smokers
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A new study that evaluated the applicability of newer individual risk-based prediction models for lung cancer screening highlights a need for new lung cancer screening methods that focus on population demographics and smoking history.
Researchers conducted a retrospective, observational cohort study of 980 patients aged at least 18 years with newly diagnosed lung cancer from 2011 to 2015 at Louisiana State University Health Sciences Center Shreveport. Of these, 33% did not meet current U.S. Preventive Services Task Force lung cancer screening guidelines. The researchers compared these individuals with the 2018 National Comprehensive Cancer Network (NCCN) Lung Cancer Screening Guidelines, which recommend low-dose chest CT screening in high-risk groups. The researchers risk-stratified these individuals as follows: high-risk group 1 (age 55 to 74 years; 30 pack-year smoking history; current smoker or quit within past 15 years; NCCN guideline recommends screening), high-risk group 2 (age 50 years; 20 pack-year smoking history; added risk factors that increase 6-year lung cancer risk to 1.3%; NCCN guideline recommends screening), moderate-risk group (6-year risk of lung cancer < 1.3%) and low-risk group (age < 50 years; < 20 pack-year smoking history).
Thirty-three percent of these individuals were aged 55 years or younger, 48.9% were Black and 95% were smokers. After risk calculation, the researchers calculated that 12.5% were categorized as high-risk group 2 according to NCCN guidelines. Of those, 65.38% were Black, according to results presented at the virtual CHEST Annual Meeting.
“Even after applying the NCCN guidelines, we are finding that a significant proportion of Black individuals were missed,” Carol S. Velez Martinez, MD, with the department of internal medicine at Louisiana State University Health Science Center Shreveport, said during the presentation. “Focusing on pack-year smoking history rather than age could be a potential way of identifying more patients at an earlier stage. [Also], perhaps we could create our own risk-based calculator suitable for our patient population.”
In July, the eligibility criteria for the USPSTF lung cancer screening guidelines were expanded and eligibility criteria now include individuals aged 50 to 80 years with a smoking history of 20 pack-years or more and those who currently smoke or quit smoking within the past 15 years. The USPSTF noted that the expanded criteria may result in more younger, Black adults who will be eligible for lung cancer screening. Of note, the current study used the previous USPSTF guideline.