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Racial and Ethnic Disparities in Lung Cancer Screening Eligibility.

Anand K Narayan¹, Divya N Chowdhry¹, Florian J Fintelmann¹

¹From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Wang 219H, Boston, MA 02114.

|September 21, 2021

Summary

Revised lung cancer screening guidelines may not reduce disparities for African American and Hispanic smokers. These groups remain less likely to be eligible for lung cancer screening (LCS) despite updated recommendations.

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Area of Science:

Public Health
Preventive Medicine
Health Disparities Research

Background:

Lung cancer screening (LCS) disparities disproportionately affect high-risk African American smokers.
Revised U.S. Preventive Services Task Force (USPSTF) guidelines lowered LCS eligibility thresholds to address these disparities.
Limited data exist on the impact of revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility.

Purpose of the Study:

To evaluate the impact of the revised USPSTF guidelines on racial and ethnic disparities in LCS eligibility.
To assess whether updated LCS criteria improve equitable access for minority populations.

Main Methods:

Retrospective analysis of cross-sectional survey data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS) across 20 states.
Included respondents aged 50-79 years without a history of lung cancer, comparing eligibility under previous (55-79) and revised (50-79) USPSTF guidelines.
Multivariable logistic regression analyses, accounting for complex survey design, were used to assess the association between race/ethnicity and LCS eligibility.

Main Results:

Under revised USPSTF guidelines, 14% of respondents were eligible for LCS, an increase from 11% under previous guidelines.
African American and Hispanic respondents remained significantly less likely to be eligible for LCS compared to White respondents under both previous (OR=0.36, OR=0.15) and revised (OR=0.39, OR=0.15) guidelines.
No significant difference was observed in the degree of disparity reduction between the previous and revised USPSTF guidelines (P = .76).

Conclusions:

The revised USPSTF guidelines for lung cancer screening may perpetuate existing racial and ethnic disparities.
African American and Hispanic smokers continue to be less likely to meet eligibility criteria for LCS, indicating a need for further interventions.
The updated guidelines have not substantially improved equitable access to lung cancer screening for minority populations.