Racial Differences in Outcomes within the National Lung Screening Trial. Implications for Widespread Implementation

Area of Science:

• Pulmonary Medicine
• Oncology
• Radiology

Background:

• Black individuals with lung cancer (LC) face higher mortality due to advanced disease presentation and lower rates of curative resection.
• The National Lung Screening Trial (NLST) showed reduced LC mortality with low-dose computed tomography (LDCT) screening, but its benefit in Black individuals was unknown.

Purpose of the Study:

• To analyze the racial disparities in lung cancer outcomes within the NLST.
• To determine the effectiveness of LDCT screening in Black individuals compared to other racial groups.

Main Methods:

• Secondary analysis of the randomized National Lung Screening Trial (NLST) conducted across 33 U.S. centers.
• Comparison of lung cancer-specific and all-cause mortality between racial groups based on LDCT screening status.

Main Results:

• LDCT screening reduced lung cancer mortality across all races, with a more pronounced effect in Black individuals (HR 0.61 vs. 0.86).
• Black smokers had double the risk of lung cancer death compared to white smokers (HR 4.10 vs. 2.25).
• Despite higher all-cause mortality in Black individuals (HR 1.35), LDCT screening led to a reduction in this group.

Conclusions:

• LDCT screening demonstrated decreased lung cancer mortality in Black individuals.
• While screening improved outcomes, demographic factors associated with better survival were less prevalent in this group.
• Improved access to care may explain the mortality reduction observed in screened Black individuals, necessitating tailored dissemination strategies.