Revised Guidelines Did Not Reduce Disparities in Lung Cancer Screening Eligibility

By Linda Carroll

September 23, 2021

(Reuters Health) - Despite adjustments to the U.S. Preventive Services Task Force lung cancer screening criteria, disparities in eligibility between racial and ethnic minorities and white patients have not changed, a new study suggests.

Based on risk factor data from a 20-state cross sectional survey, researchers found that minorities are anywhere from 85% to 61% less likely than white individuals to be eligible for lung cancer screening under the newer guidelines. While the overall number of eligible people increased under the new guidelines, the eligible proportions of minority populations remained similar to proportions under the old guidelines, according to the results published in Radiology.

In the study, the researchers compared screening eligibility under USPSTF guidelines issued in 2015 to eligibility under revised guidelines issued in March of 2021, which lowered the age threshold from 55 to 50 and the level of smoking from 30 pack-years to 20-pack years.

The study was motivated by a concern that the revisions might still miss minorities because of a continued reliance on age and pack-year thresholds, the authors said in a statement.

"Revised lung cancer screening eligibility criteria may perpetuate lung cancer disparities," first author Dr. Anand Narayan, an associate professor in the department of radiology at the University of Wisconsin, Madison told Reuters Health. "Guidelines are often based on small studies that have small numbers of racial and ethnic minorities. If we aren't intentional about including the perspective of minority patients in our studies, we will continue to perpetuate health inequities."

To take a closer look at disparities in lung cancer screening under the newer guidelines, Dr. Narayan and his colleagues used de-identified data from the 2019 Behavioral Risk Factor Surveillance System survey, which includes responses about health-related behaviors, chronic diseases, and the use of preventive services.

Male and female survey participants without a history of lung cancer and with a self-reported current or former smoking history were included in their analysis. A total of 67,567 participants aged 55-79 were assessed for eligibility under the earlier USPSTF criteria and 77,689 participants aged 50 to 79 were assessed under the revised guidelines.

Overall, the proportion of respondents eligible for lung cancer screening rose from 10.9% before the revisions to 13.7% afterward, but the disparities remained. Under the old guidelines, 12% of white survey participants would have been eligible, along with 4% of Hispanic, 7% of Black, 17% of American Indian, 4% of Asian or Pacific Islander, and 12% of other participants.

Under the new guidelines, those proportions were: White (15%), Hispanic (5%), Black (9%), American Indian (21%), Asian or Pacific Islander (5%), and other (18%).

The new paper shows that the revised guidelines "moved the needle for the general population, but did not improve disparities among minorities," said Dr. Panagis Galiatsatos, an assistant professor in the division of pulmonary and critical care medicine at the Johns Hopkins University School of Medicine in Baltimore and director of the Tobacco Treatment Clinic at Johns Hopkins Medicine. "We need to come up with strategies to address those disparities."

One thing that would help would be to "remove the stigma and marginalization of those who smoke," Dr. Galiatsatos said. "Lung cancer is really stigmatized. People think that the patients brought it on themselves. We as clinicians need to check ourselves, our own implicit biases. We need to make sure we treat these patients with the same respect we give to every other patient."

Dr. Galiatsatos points to a recent clinic at Johns Hopkins that offered same-day lung cancer screenings. "We did them on a lot of patients, minorities and those from socioeconomically disadvantaged neighborhoods," he said. "If you have a smoking clinic, you can add in screening."

SOURCE: Radiology, online September 21, 2021.