Do 2021 USPSTF Lung Cancer Screening Criteria Eliminate Racial Disparities?

The 2021 US Preventive Services Task Force (USPSTF) guideline for lung cancer screening broadens eligibility for screening and decreases the racial disparity in access to screening, thus resolving significant issues present in earlier, fixed screening criteria. This was among study findings recently published in JAMA Oncology.

In the current study, investigators sought to compare the 2021 USPSTF lung cancer screening criteria with other lung cancer screening criteria, as well as to assess whether the sensitivity and specificity of these criteria vary according to race. The study evaluated whether patients with lung cancer and controls would have qualified for lung cancer screening with the 2013 USPSTF, the 2021 USPSTF, the National Comprehensive Cancer Network (NCCN) group 2 criteria, and the 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) screening criteria. Sensitivity was defined as “the percentage of patients with lung cancer who qualified for screening,” whereas specificity was defined as “the percentage of controls who did not qualify for lung cancer screening.”

A retrospective study was conducted among participants with and without lung cancer from the Detroit metropolitan area who were initially recruited for the Inflammation, Health, Ancestry, and Lung Epidemiology (INHALE) study. Study participants comprised 912 patients with a diagnosis of lung cancer, 493 of whom were women. The mean age of the participants with lung cancer was 63.7±9.5 years. A total of 1457 individuals without lung cancer at enrollment served as the control group; 795 of these were women.  The mean age in the control arm was 60.4±9.6 years. The 912 participants with lung cancer included 69% White individuals and 31% Black individuals. White patients with lung cancer had significantly higher mean smoking pack-years than Black patients with lung cancer (49.0±29.6 vs 37.0±24.0, respectively; P <.001).

When the 2021 USPSTF criteria were used, 65% (590 of 912) of patients were eligible for screening, compared with 68% (619 of 912) of patients with the PLCOm2012 criteria and 49% (445 of 912) with the 2013 USPSTF criteria. With utilization of the 2013 USPSTF criteria, significantly more White patients with lung cancer than Black patients with lung cancer would have been eligible for screening (52% [324 of 625] vs 42% [121 of 287], respectively; P =.007). This racial disparity was still present when the NCCN group 2 criteria were used (67% [417 of 625] of White patients vs 51% [146 of 287] of Black patients; P <.001).  This racial gap between White and Black individuals was absent, however, when the 2021 USPSTF criteria or the PLCOm20 criteria were utilized (65% [408 of 625] of White patients vs 63% [182 of 287] of Black patients with 2021 USPSTF criteria and 68% [427 of 625] of White patients vs 67% [192 of 287] of Black patients with PLCOm20 criteria).

Overall, the 2013 USPSTF criteria excluded 65% (950 of 1457) of participants in the control group, whereas the PLCOm20 criteria excluded 58% (843 of 1457) of the control group and the 2021 USPSTF criteria excluded 49% (709 of 1457). Per the 2013 USPSTF criteria, fewer White participants vs Black participants in the control group were excluded (61% [514 of 838] vs 70% [436 of 619], respectively. Once again, this racial disparity was not present when the 2021 USPSTF criteria (48% [401 of 838] of White patients vs 50% [308 of 619] of Black patients) and the PLCOm2012 guidelines (57% [475 of 838] of White patients vs 60% [368 of 619] of Black patients) are used.  

“As expected, broader inclusion criteria increased sensitivity, but at the cost of decreased specificity,” the investigators noted, adding: “These guidelines effectively

eliminated the racial disparity in eligibility seen with the previous fixed-criteria models of the [National Lung Screening Trial] and 2013 USPSTF guidelines and the NCCN group 2 guidelines. In our study, the sensitivity and specificity of the 2021 USPSTF guidelines are close to those of the predictive model–based PLCOm2012 criteria but are much more straightforward to use in a clinical setting.”

The researchers further suggested that a large prospective trial with multiracial representation is warranted.

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. 

Reference  

Pu CY, Lusk CM, Neslund-Dudas C, Gadgeel S, Soubani AO, Schwartz AG. Comparison between the 2021 USPSTF lung Cancer screening criteria and other lung cancer screening criteria for racial disparity in eligibility. JAMA Oncol. Published online January 2022. doi:10.1001/jamaoncol.2021.6720