Lung Cancer Screening Eligibility Highlights Health Disparities

Despite revised guidelines for lung cancer screening eligibility, health disparities among racial and ethnic minorities are persisting, according to the Radiological Society of North America.

In 2014, the United States Prevention Services Task Force recommended lung cancer screening with low-dose chest CT in high-risk individuals to reduce cancer-related mortality. The original eligibility guidelines had limitations because they were based on studies in which only 4 percent of participants were Black and smokers.

In March 2021, the task force expanded eligibility, lowering the requirements for lung cancer screening eligibility from age 55 to 50 and from at least 30 to at least 20 pack-years of smoking. Pack-years are the number of packs smoked per day multiplied by the number of years smoking.

The revised guideline, made in part to address health disparities in screening, raised concerns over their continued use of age and pack-year thresholds.

“It was great to expand eligibility, but to just change the age and the pack-years doesn’t fully address lung cancer risk,” radiologist and vice-chair of equity in the Department of Radiology at the University of Wisconsin in Madison Anand Narayan, MD, PhD, said in a press release.

“We’ve long known that some racial/ethnic minorities face a higher risk of lung cancer, and that level of risk is not adequately reflected in the new guidelines.” 

To examine health disparities in lung cancer screenings, Narayan and colleagues examined data from the 2019 Behavioral Risk Factor Surveillance System Survey, including more than 77,000 respondents.

The survey showed that the proportion of respondents eligible for lung cancer screening rose from 10.9 percent before the revisions to 13.7 percent after. However, Black, Hispanic, and Asian/Pacific Islander populations remained less likely than Whites to be eligible for screenings.

Under the new guidelines, 14.7 percent of eligible individuals were Whites, 9.1 percent were Black, 4.5 percent were Hispanic, and 5.2 percent were Asian/Pacific Islander.

“Unfortunately, we saw no evidence that there was any change in the eligibility disparities for racial/ethnic minorities,” Narayan said. “Even though the new criteria were created in part to address the disparities, they don’t reflect the fact that racial/ethnic minorities are at higher risk.”

According to Narayan, a better way to address disparities is to incorporate risk models into eligibility guidelines. Risk models can go beyond age and packyears to include social determinants of health, family history, and chronic diseases.

“If we put social determinants of health into our model, then we can more accurately reflect risk,” Narayan said. “It can give us tools to direct our resources toward patients in terms of how much risk they are experiencing and how much care they actually need. We can then target high-risk patients for more intensive screening and diagnostic services.”

Narayan noted that in breast cancer screenings, women are eligible for supplementary screening with MRI if their lifetime risk of developing breast cancer is higher than 20 percent. A similar model would be incorporated into lung cancer screening, potentially making diverse populations eligible for lung cancer screenings.

“In a country that is so diverse and has patients in so many different circumstances, I feel as though we need new solutions to adequately reflect lung cancer risk for our patients and reduce lung cancer disparities in racial/ethnic minorities,” Narayan said.