Lung Cancer Screening Eligibility: Is Pack-Year Smoking History an Inadequate Measure?

By: Bryna Goeking
Posted: Tuesday, May 14, 2024

Pack-year smoking history, a method of tobacco exposure by smoking intensity and duration, may exclude many high-risk individuals, according to a recent study in the Journal of Clinical Oncology. The study, conducted by Chi-Fu Jeffrey Yang, MD, of Massachusetts General Hospital, Boston, and colleagues, found that using a 20-year smoking duration cutoff may improve selection of individuals for screening, including those from racial and ethnic minority groups.

“Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black vs White individuals,” the authors said.

Dr. Yang and colleagues analyzed nearly 50,000 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and approximately 22,000 from the Black Women’s Health Study (BWHS). Under current U.S. Preventive Services Task Force (USPSTF) guidelines, only 58% of Black patients and 74% of White patients with lung cancer in the SCCS would have qualified for screening (P < .001). Switching to the 20-year smoking duration guideline would increase the number of patients screened to 85.3% for Black patients and 82.0% for White patients within the SCCS group. In the BWHS, the screening percentage increased from 42.5% to 63.8% after the guideline change.

Pack-year smoking history is the current USPSTF guideline. Smoking duration by year considers all consumption within that time. Previous studies have shown smoking duration to be more strongly associated with lung cancer than intensity. This is the first study comparing these two screening criteria in populations with lung cancer.

Disclosure: The study authors reported no conflicts of interest.

Journal of Clinical Oncology

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