Risk-Based Lung Cancer Screening May Reduce Racial, Ethnic Disparities

Researchers have demonstrated that a risk-based lung cancer screening model may reduce racial and ethnic disparities and improve screening efficiency compared to national lung cancer screening guidelines across multiple races and ethnicities in the United States, according to a study published recently in JAMA Oncology.

The research team indicated that the revised 2021 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening—which recommend annual screening for adults aged 50 to 80 with a 20 pack-year smoking history and currently smoke or have quit within the past 15 years—have reduced disparities between African American and White patients compared to the 2013 guidelines.

However, the researchers also noted that potential disparities across other racial and ethnic groups in the US are currently unknown. Risk model-based screening has the potential to help reduce some of these disparities, but the validation of existing risk models and their screening performance has been assessed within the context of race and ethnicity.

To address this, the research team aimed to validate and recalibrate the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) model. PLCOm2012 is an established risk prediction model, but it is predominately based on a White population.

In validating and recalibrating the tool, the researchers sought to make it suitable for use across races and ethnicities in the US.

From there, the team would assess racial and ethnic disparities and screening performance through risk-based screening via PLCOm2012 and the USPSTF 2021 criteria.

To do so, the researchers gathered data from 105,261 African American, Japanese American, Latino, Native Hawaiian/Other Pacific Islander, and White patients from the Multiethnic Cohort Study, which enrolled participants from 1993-1996.

All patients had a smoking history and were followed up through December 31, 2018.

For each patient, six-year lung cancer risk and screening eligibility were determined using PLCOm2012 and the USPSTF 2021 criteria.

Approximately 1.4 percent of the cohort developed lung cancer within six years of study enrollment.

The PLCOm2012-Update tool demonstrated good predictive accuracy across races and ethnicities with an area under the curve of 0.72-0.82. However, the 2021 US Preventive Services Task Force guidelines yielded significant disparities for African American individuals, whose eligibility-incidence ratio was 53 percent lower than that of White participants.

Leveraging the PLCOm2012-Update tool for risk-based screening substantially reduced these disparities, and minimal disparities were observed among the other minoritized groups in the study cohort.

Overall, risk-based screening yielded superior race and ethnicity–specific performance compared to the USPSTF 2021 criteria, with a higher sensitivity and lower number needed to screen at a similar specificity.

The researchers concluded that these findings suggest that risk-based lung cancer screening may improve screening performance and reduce disparities across races and ethnicities over the 2021 USPSTF guidelines.

The study is part of a larger push in medical research to investigate and address cancer disparities through data analytics.

In 2021, researchers from UC San Diego Health compared clinical trial participation from 2015-2019 to the proportion of cancer incidence rates from 2015- 2017 among various populations: minoritized patients versus non-Hispanic White patients, females versus males, and elderly versus non-elderly individuals.

They found that despite attempts to increase clinical trial participation, certain cancer patient populations remain significantly underrepresented.

To close these gaps, the research team recommended that additional efforts be undertaken to address the underrepresentation of older patients and women in these clinical trials.