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Related Experiment Video

Updated: Jul 13, 2026

Pathological Analysis of Lung Metastasis Following Lateral Tail-Vein Injection of Tumor Cells
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Addressing algorithmic bias in lung cancer screening eligibility.

Adoma Manful1, Sarah Mercaldo2,3, Jeffrey D Blume4

  • 1Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.

Journal of the National Cancer Institute
|December 29, 2025
PubMed
Summary

Current lung cancer screening guidelines show racial bias, underidentifying Black individuals. Race-aware strategies are essential for equitable lung cancer screening eligibility and improved outcomes.

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Area of Science:

  • Public Health
  • Health Equity
  • Medical Informatics

Background:

  • Lung cancer screening guidelines, including USPSTF, are based on predominantly White populations.
  • Existing strategies exhibit algorithmic bias, performing inconsistently across diverse racial groups.
  • This inconsistency suggests a need to re-evaluate eligibility criteria for equitable application.

Purpose of the Study:

  • To assess the performance of current lung cancer screening eligibility strategies in a predominantly Black/African American cohort.
  • To explore methods for resolving algorithmic bias to enhance equity in lung cancer screening eligibility.
  • To propose and evaluate novel race-aware strategies.

Main Methods:

  • Utilized the Southern Community Cohort Study (predominantly Black/African American participants).
  • Evaluated eight existing lung cancer screening eligibility strategies and two new race-aware strategies.
  • Compared performance metrics such as sensitivity and false positive rates across racial groups.

Main Results:

  • Existing strategies identified fewer Black/AA participants as eligible for lung cancer screening compared to White participants.
  • Removing race or other criteria did not resolve racial disparities in eligibility.
  • Race-aware strategies demonstrated the best sensitivity-specificity trade-off, minimizing inequities.

Conclusions:

  • Algorithmic bias in lung cancer screening eligibility is evident in current guidelines.
  • Race-aware approaches are crucial for addressing disparities and ensuring equitable access to lung cancer screening.
  • Tailoring eligibility thresholds by race can improve fairness and effectiveness.