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  1. Home
  3. Pack-year Smoking History: An Inadequate And Biased Measure To Determine Lung Cancer Screening Eligibility.
  1. Home
  3. Pack-year Smoking History: An Inadequate And Biased Measure To Determine Lung Cancer Screening Eligibility.

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Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility.

Alexandra L Potter1, Nuo N Xu2, Priyanka Senthil1

  • 1Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|March 27, 2024

View abstract on PubMed

Summary
This summary is machine-generated.

Replacing pack-years with smoking duration for lung cancer screening eligibility significantly increases access for Black patients and reduces racial disparities. This change improves lung cancer detection rates and equity in preventive care.

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Area of Science:

  • Pulmonary Medicine
  • Oncology
  • Public Health

Background:

  • Pack-year smoking history is a standard but flawed metric for assessing cumulative tobacco exposure.
  • Current US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening may exclude high-risk individuals, particularly racial and ethnic minorities, due to reliance on pack-years.
  • The effectiveness of using smoking duration as an alternative criterion is not well-established.

Purpose of the Study:

  • To evaluate whether a smoking duration criterion improves lung cancer screening eligibility compared to the pack-year criterion.
  • To determine if a smoking duration cutoff can reduce racial disparities in lung cancer screening access.

Main Methods:

  • Analysis of 49,703 individuals from the Southern Community Cohort Study (SCCS) and 22,126 from the Black Women's Health Study (BWHS).
  • Comparison of lung cancer screening eligibility under the current USPSTF guideline (≥20 pack-years) versus a proposed guideline (≥20 years smoking duration).

    • Main Results:

    • The USPSTF guideline identified only 57.6% of Black patients with lung cancer in the SCCS, versus 74.0% of White patients (p < .001).
    • The proposed 20-year smoking duration criterion increased eligibility to 85.3% for Black patients and 82.0% for White patients in the SCCS, eliminating the disparity.
    • In the BWHS, the duration criterion raised screening eligibility for Black women with lung cancer from 42.5% to 63.8%.

    Conclusions:

    • A 20-year smoking duration cutoff substantially increases lung cancer screening eligibility for patients.
    • This change effectively eliminates racial disparities in screening eligibility between Black and White individuals.
    • Smoking duration is a more precise measure of exposure and simpler to calculate than pack-years.