Reducing Smoking Requirements for Lung Screening to Address Health Disparities in a Community Cohort

Area of Science:

• Pulmonology
• Oncology
• Public Health

Background:

• Lung cancer screening (LCS) criteria, such as those from the US Preventive Services Task Force (USPSTF), often exclude individuals who could benefit.
• Existing criteria may be less effective due to race-based and sex-based differences in smoking patterns.

Purpose of the Study:

• To evaluate the impact of expanding LCS eligibility criteria by relaxing smoking exposure requirements.
• To assess if modified criteria improve access to screening and diagnostic yield, especially for underrepresented groups.

Main Methods:

• A cohort study analyzed data from individuals in incidental pulmonary nodule (IPN) and LCS programs (2015-2023).
• Eligibility was assessed using USPSTF 2021, Potter (20-year history), and American Cancer Society (ACS; 20 pack-years) criteria, with relaxed expansions (10 years/10 pack-years).
• Statistical comparisons (chi-squared, Wilcoxon-Mann-Whitney) were used to analyze differences between groups.

Main Results:

• Over 43,000 individuals were evaluated; expanded criteria identified significantly more eligible women and Black individuals.
• The Potter criteria (20-year history) identified 16% of IPN participants as eligible, with 18% diagnosed with lung cancer.
• Relaxing criteria to 10 years or 10 pack-years would make an additional 27% of IPN participants eligible, with 16% diagnosed with lung cancer.

Conclusions:

• Modifying LCS criteria, such as using a 20-year smoking history, enhances screening accessibility, particularly for women and Black individuals.
• The diagnostic efficiency is maintained with these expanded criteria.
• Further research into even more relaxed criteria (10-year or 10 pack-year history) is recommended to broaden LCS eligibility.