Evaluation of USPSTF lung cancer screening guidelines for African-American smokers

Bottom Line: An observational study suggests the U.S. Preventive Services Task Force (USPSTF) lung cancer screening guidelines may be too conservative for African American smokers and that some eligibility criteria changes could result in more screenings of African American smokers at high risk for lung cancer. The study looked at new lung cancer cases in a predominantly low-income and African American population group to assess their eligibility for lung cancer screening using the USPSTF criteria. The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This study included 48,364 adults who ever smoked (67% were African American) and 1,269 new lung cancers were identified. Among the smokers, 17% of African  American smokers were eligible for USPSTF screening compared with 31% of white smokers. The lower percentage of lung cancer cases eligible for screening among African American smokers was largely associated with fewer smoking pack-years (a measure of smoking) among African American smokers compared with white smokers. African Americans tend to smoke fewer cigarettes per day and tend to have a lower overall smoking pack-year history compared with white smokers. These study results suggest that lowering the smoking pack-year eligibility requirement from 30 to 20 pack years for African American smokers could increase the number of African American smokers eligible for screening. In addition, reducing the minimum age criterion for screening to 50 for African American smokers could further increase eligibility. The average age of a lung cancer diagnosis tends to be earlier for African American smokers compared with white smokers. This study has limitations to consider, including that smoking was self-reported and authors didn’t have information about actual lung cancer screening use.

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Authors: Melinda C. Aldrich, Ph.D., of the Vanderbilt University Medical Center, Nashville, Tennessee, and coauthors

(doi:10.1001/jamaoncol.2019.1402)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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