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Related Concept Videos

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Risk Model-Based Lung Cancer Screening and Racial and Ethnic Disparities in the US.

Eunji Choi1,2, Victoria Y Ding1, Sophia J Luo1

  • 1Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California.

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|October 26, 2023
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Summary
This summary is machine-generated.

Risk-based lung cancer screening significantly reduces racial disparities and improves screening performance compared to current USPSTF 2021 guidelines. This approach enhances lung cancer detection across diverse ethnic groups.

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Area of Science:

  • Oncology
  • Public Health
  • Epidemiology

Background:

  • The 2021 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening reduced disparities for African American vs. White individuals but did not address other groups.
  • Risk model-based screening may mitigate disparities and improve lung cancer screening performance, yet validation across diverse populations is lacking.

Purpose of the Study:

  • To validate and recalibrate the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) model across U.S. racial and ethnic groups.
  • To evaluate disparities and screening performance using risk-based screening with the PLCOm2012 model versus the USPSTF 2021 criteria.

Main Methods:

  • Utilized the Multiethnic Cohort Study (105,261 participants) with data from 1993-2018.
  • Calculated 6-year lung cancer risk using a recalibrated PLCOm2012 model (PLCOm2012-Update) and assessed screening eligibility (≥1.3% risk).
  • Compared screening performance (eligibility-incidence ratio, sensitivity, specificity, number needed to screen) between risk-based screening and USPSTF 2021 criteria across racial/ethnic groups.

Main Results:

  • The PLCOm2012-Update demonstrated good predictive accuracy (AUC, 0.72-0.82) across races and ethnicities.
  • USPSTF 2021 criteria showed significant disparities, with a 53% lower eligibility-incidence ratio for African Americans vs. White individuals.
  • Risk-based screening substantially reduced this disparity (E-I ratio: 15.9 vs. 18.4) and showed minimal disparities in other minority groups.
  • Risk-based screening improved overall sensitivity (67.2% vs. 57.7%) and reduced the number needed to screen (26 vs. 30) compared to USPSTF 2021 criteria, at similar specificity (76.6%).

Conclusions:

  • Risk-based lung cancer screening effectively reduces racial and ethnic disparities.
  • This approach improves lung cancer screening performance across diverse populations compared to the USPSTF 2021 criteria.