Increased Lung Cancer Screening Tied to Lower Mortality for Black People

By Lisa Rapaport

August 30, 2021

(Reuters Health) - Expanding access to lung cancer screening for Black people who are current or former smokers is associated with a larger reduction in mortality than previously thought, a U.S. study suggests.

Researchers examined data on 53,452 participants in the National Lung Screening Trial (NLST), a randomized clinical trial that compared lung cancer and all-cause mortality with low-dose computed tomography (LDCT) versus chest radiograph. This population had 2,376 (4.4%) Black individuals; researchers noted that this underrepresented Black people, who make up 13.4% of the U.S. population.

For the current analysis, researchers used a transportability formula to estimate mortality with LDCT screening among hypothetical populations with different proportions of current smokers, women, and Black individuals.

When researchers ran their calculations with a hypothetical population that was 13.4% Black, similar to the U.S. general population, they found LDCT screening tied to an 18% reduction in lung cancer mortality, compared to a 16% reduction in lung cancer mortality in the NLST trial. At this proportion of Black individuals, LDCT screening was also associated with an 8% reduction in all-cause mortality.

Similarly, when researchers increased the proportion of Black individuals in the population to 46.3%, similar to the population of Washington, D.C., they found LDCT screening associated with a 26% reduction in lung cancer mortality. At this proportion of Black individuals, LDCT screening was also associated with a 13% reduction in all-cause mortality, according to the results in JAMA Network Open.

"Recognizing historically poor lung cancer outcomes in Black patients, and noting that among the NLST participants just over 4% identified as Black, what we've demonstrated here is that lung screening not only works well when more Black individuals are included, but estimates for our population level outcomes are improved," said lead study author Dr. Ashley Elizabeth Prosper, chief of cardiothoracic imaging and co-director of the lung cancer screening program at the University of California, Los Angeles.

Providing equal access to health care, including lung screening, is critical to decreasing health disparities, Dr. Prosper said by email.

"The data in this study adds credence to that belief and emphasizes the importance of equity in access to lung screening across our population," Dr. Prosper said.

One limitation of the study is that the statistical method used to calculate the mortality benefit of screening isn't as accurate as running clinical trials that are inclusive of Black individuals in proportion to their representation in the general population, the study team notes. In addition, people who participate in clinical trials may not be representative of patients in the general population, particularly when it comes to screening adherence, the authors point out.

"The question about how to get more Black patients screened for lung cancer is linked to the amount of effort we place into our outreach, and our ability to engage in with communities of color in a manner that is respectful, and engenders trust," said Dr. Christopher Lathan, chief clinical access and equity officer at Dana-Farber Cancer Institute in Boston and author of a commentary accompanying the study.

There's a need for viable, sustainable clinical pathways that consider the structural barriers to screening and treatment that patients may face, Dr. Lathan said by email.

"A lung cancer screening program is not just about screening, it is about prevention, diagnosis, and expediting effective treatments for patients who do have lung cancer," Dr. Lathan said. "Creating an opportunity to do this in a proactive thoughtful manner is how we improve mortality."

SOURCE: https://bit.ly/3sQTJtH and https://bit.ly/3ynCAc6 JAMA Network Open, online August 24, 2021.

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