Revised USPSTF Lung Cancer Screening Guidelines May Benefit Racial Minorities

Doctor looking at lung scans.
Doctor looking at lung scans.
Research presented at CHEST 2021 examined how expanded USPSTF lung cancer screening criteria would affect minorities and women.

The following article is a part of conference coverage from CHEST 2021, being held virtually from October 17 to October 20, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from CHEST 2021.


Expanding eligibility for lung cancer screening in the US can potentially improve survival rates, especially among Black Americans, according to research were presented at the CHEST 2021 Annual Meeting, held virtually October 17 to 20.

Researchers conducted a retrospective cohort study of patients with lung cancer who were seen between 2005 and 2015 at the Los Angeles County (LAC) Hospital or the University of Southern California Norris Comprehensive Cancer Center (NCCC). Investigators sought to assess the potential impact of change linked to the July 2020 United States Preventive Services Task Force (USPSTF) proposal to loosen screening criteria for lung cancer, such that individuals aged 50 years and older with a 20 pack-year or greater history of smoking would become eligible for screening. Researchers specifically focused on the effect this change would likely have on women and individuals of various ethnic/racial minorities.

The charts of 664 patients with lung cancer evaluated at the LAC Hospital or NCCC were reviewed, with demographic data, family history of cancer, and smoking status taken into account. Researchers determined that under the original USPSTF guidelines (ie, age ≥55 years, ≥30 pack-years), only 30.3% (201 of 664) of the patients studied would have qualified for lung cancer screening, with 63.5% (421 of 664) of the patients failing to meet eligibility criteria because of their smoking history alone. Based on the revised USPSTF guidelines, however, which have a lower the age requirement and smoking threshold (age ≥50 years, ≥20 pack years), a statistically significant additional 13.2% of the patients would have qualified for lung cancer screening (P <.001).

Per gender-related differences, the analysis found that the revised guidelines would increase screening eligibility in men by 16.5% and in women by 10.2% (P <.001 for both). Stratification by ethnicity found that the revised guidelines would increase screening eligibility in Black individuals by 30.2% (P <.001), in White individuals by 13.3% (P =.010), in Hispanic individuals by 12.5% (P =.012), and in Asian individuals by 8.5% (P =.048).

The investigators concluded that the original USPSTF lung cancer screening criteria benefit only a small subset of individuals with the disease. Future research is warranted to explore whether eliminating the need for tobacco use criteria altogether would be associated with an even higher success rate in the diagnosis of early lung cancer, particularly among women and in minorities with a high prevalence of developing lung cancer not related to smoking.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Vu CF, Rodman J, Wilson M, et al. Impact of expanding lung cancer screening guidelines on the early detection of lung cancer in women and minorities. Presented at: CHEST 2021; October 17-20, 2021; Orlando, FL/Virtual. Abstract A1611-A1612.