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Analyzing the Racial Disparities in Lung Cancer Screening Eligibility: Focus on 2021 USPSTF Criteria

By: Gavin Calabretta, BS
Posted: Friday, March 25, 2022

In 2021, the U.S. Preventive Services Task Force (USPSTF) broadened its criteria for lung cancer screening. Retrospectively enrolling patients from the Detroit-based Inflammation, Health, Ancestry and Lung Epidemiology study, Ann G. Schwartz, MPH, PhD, of Wayne State University, Detroit, and colleagues compared the updated 2021 and previous 2013 USPSTF criteria with other guidelines to identify racial disparities in screening eligibility. According to their findings, which were published in JAMA Oncology, the updated criteria have broadened eligibility for screening to include more Black individuals.

“The predictive model risk-based criteria using PLCOm2012 [the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial] still has higher sensitivity and specificity in selecting those who will most benefit from lung cancer screening, although its implementation remains difficult,” stated the authors.

In total, 912 patients with lung cancer, and 1,457 individuals without lung cancer (controls) were included. All participants had a history of smoking. Along with USPSTF criteria, the analysis included National Comprehensive Cancer Network (NCCN) group 2 guidelines, and predictive model risk-based criteria from the 2012 PLCO (PLCOm2012).

The 2013 USPSTF criteria showed a racial disparity in lung cancer screening eligibility. Significantly more White than Black patients with lung cancer (324 of 625 [52%] vs. 121 of 287 [42%]) would have been eligible for screening. This disparity eased using 2021 USPSTF criteria (65% vs. 63%) and PLCOm2012 criteria (68% vs. 67%), but it remained with NCCN group 2 criteria (67% vs. 51%). Also, the 2013 criteria excluded fewer White than Black control participants from screening (514 of 838 [61%] vs. 436 of 619 [70%]). This disparity was not present using the 2021 USPSTF criteria (48% vs 50%) or PLCOm2012 guidelines (57% vs. 60%), but it was still present using NCCN criteria (55% vs. 64%).

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.


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