Study Results Link Lung Cancer Screening Guideline Changes to Racial Disparity Reductions

Changes in 2021 to the US Preventive Services Task Force (USPSTF) lung cancer screening guidelines were associated with reductions in existing eligibility disparities in lung cancer screening among Black and white individuals but not the elimination of disparities, new study results showed.

Factors beyond age and pack per year of smoking should be considered when creating guidelines to improve screening eligibility for individuals at high risk of lung cancer, investigators said.

In the study, investigators included 5787 individuals who identified as Black and 8498 individuals who identified as white.

Of the individuals, 1109 who were Black and 2313 who were white, where eligible for cancer screening, based on the 2013 USPSTF guidelines. However, based on the 2021 USPSTF guidelines, 1667 individuals, who were Black, and 2940 individuals, who were white, were eligible for screening.

After adjustments for the differences in characteristics and residential segregations, investigators found that the 2013 difference in screening eligibility, among individuals who were Black and those who were white, was -12.66% and the 2021 difference was -12.15%.

Investigators aimed to find the differences in the proportion of Black and white individuals who were eligible for lung cancer screening in 2013 and 2021, which were assessed using modified Poisson models. The primary exposure variable was self-reported race.

Covariate selection was determined by the Commission on Social Determinants of Health framework by the World Health Organization. The 2 categories that investigators focused on were political and socioeconomic and class and and social hierarchy, including annual household income, health insurance status, highest level of education, and sex.

The associations between demographic characteristics and social factors associated with health, differences in screening eligibility; and the dissimilarity and interaction indices, which were 2 measures of residential segregation, were recorded by the investigators.

Data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were used in this study. The REGARDS study comprised community-dwelling individuals from the United States who were Black and white, aged 45 years and older, and were recruited between January 2003 and October 2007 with ongoing follow up.

All individuals who were potentially eligible for lung cancer screening based on the 2021 USPSTF guidelines were included. The follow-up data for the current cohort study were collected and analyzed between January 2013 and December 2017, with a final analysis in 2021.

The measures of residential segregation did not capture the full context of the individuals’ daily lives outside the residential neighborhood, investigators said.

In addition, the REGARDS inclusion criteria required individuals to have a home address and telephone number, which could have eliminated some of the most vulnerable members of the population, they said.

Although the REGARDS cohort is large, it is not nationally representative, so the observed rates are limited to the specific population, investigators said.

Reference

Pinheiro LC, Groner L, Soroka O, et al. Analysis of eligibility for lung cancer screening by race after 2021 changes to US Preventive Services Task Force Screening guidelines. JAMA Netw Open. 2022;5(9):e2229741. doi:10.1001/jamanetworkopen.2022.29741