Lower Calculated Lung Cancer Risk in Black Patients Eligible for Screening

After careful consideration, the American Thoracic Society canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from May 15-20, because of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting. A virtual event is being planned for later this year.

Compared with white patients, black patients with screen-detected cancers had a lower calculated lung cancer risk, despite having a significantly higher mean 6-year lung cancer risk, according to findings intended to be presented at the American Thoracic Society (ATS) International Conference. (Select research is slated to be presented in a virtual format later this year.)

Lung cancer screening that uses individualized lung cancer risk calculations may be more cost-effective and have greater accuracy than current screening criteria because risk factors for lung cancer may not be the same in patients of different races. Therefore, researchers sought to identify race-dependent differences in 6-year lung cancer risk in a lung cancer screening-eligible population. Researchers calculated the 6-year lung cancer risk using the PLCO 2012 model (Prostate, Lung, Colorectal, and Ovarian Screening Trial) and created risk quartiles using median risk values (quartile 1: <2.833%, quartile 2: 2.834%-5.0%, quartile 3: 5.1%-8.8%, and quartile 4: >8.8%).

A total of 655 patients (357 white and 298 black) were enrolled into the screening program between January 2018 and August 2019. Black patients had a significantly higher mean 6-year lung risk at 8.0% (range, 0.59%-52.2%) compared with white patients at 6.1% (range, 0.01%-38.5%; P <.0001). In addition, more than half of the black patients compared with white patients had lung cancer risk within the highest risk quartiles vs the lowest risk quartiles. Black patients had fewer pack-years of smoking compared with white patients, but there were no significant differences in age.

Multivariate analysis indicated that black patients had a mean risk score that was 2.574% higher than white patients, controlling for age, sex, smoking status, pack-years, body mass index personal cancer history, family lung cancer history, chronic obstructive pulmonary disease, education, and insurance status (P <.001). A total of 12 patients (6 per patient group) were diagnosed with lung cancer. Mean 6-year lung cancer risk for white vs black patients was 10.8% vs 4.8%, respectively.

Ultimately, despite a significantly higher mean 6-year lung cancer risk in black patients undergoing low-dose computed tomography for lung cancer screening, black patients with screen-detected cancers had a lower calculated lung cancer risk.  

“Lung cancer risk prediction using currently establish models may have lower accuracy among black patients,” the researchers wrote, suggesting “that other factors such as biological differences, dietary choices, and neighborhood variables may play a role in lung cancer risk.”

Reference

Shusted CS, Juon H, Ruane B, et al. Calculated six-year lung cancer risk is differentially enriched among black and white patients eligible for lung cancer screening. Am J Respir Crit Care Med. 2020;201:A5996.

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