Abstract
Introduction
Low-dose computed tomography (LDCT) screening reduces lung cancer mortality, but current
eligibility criteria underestimate risk in women and racial minorities. We evaluated
the impact of screening criteria modifications on LDCT eligibility and lung cancer
detection.
Methods
Using data from a Lung Nodule Program, we compared persons eligible for LDCT by the
following: U.S. Preventive Services Task Force (USPSTF) 2013 criteria (55–80 y, ≥30
pack-years of smoking, and ≤15 y since cessation); USPSTF2021 criteria (50–80 y, ≥20
pack-years of smoking, and ≤15 y since cessation); quit duration expanded to less
than or equal to 25 years (USPSTF2021-QD25); reducing the pack-years of smoking to
more than or equal to 10 years (USPSTF2021-PY10); and both (USPSTF2021-QD25-PY10).
We compare across groups using the chi-square test or analysis of variance.
Results
The 17,421 individuals analyzed were of 56% female sex, 69% white, 28% black; 13%
met USPSTF2013 criteria; 17% USPSTF2021; 18% USPSTF2021-QD25; 19% USPSTF2021-PY10;
and 21% USPSTF2021-QD25-PY10. Additional eligible individuals by USPSTF2021 (n = 682)
and USPSTF2021-QD25-PY10 (n = 1402) were 27% and 29% black, both significantly higher
than USPSTF2013 (17%, p < 0.0001). These additional eligible individuals were 55% (USPSTF2021) and 55% (USPSTF2021-QD25-PY10)
of female sex, compared with 48% by USPSTF2013 (p < 0.05). Of 1243 persons (7.1%) with lung cancer, 22% were screening eligible by
USPSTF13. USPSTF2021-QD25-PY10 increased the total number of persons with lung cancer
by 37%. These additional individuals with lung cancer were of 57% female sex (versus
48% with USPSTF2013, p = 0.0476) and 24% black (versus 20% with USPSTF2013, p = 0.3367).
Conclusions
Expansion of LDCT screening eligibility criteria to allow longer quit duration and
fewer pack-years of exposure enriches the screening-eligible population for women
and black persons.
Keywords
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Article info
Publication history
Published online: October 05, 2022
Accepted:
September 21,
2022
Received in revised form:
September 20,
2022
Received:
August 18,
2022
Footnotes
Disclosure: Dr. Osarogiagbon reports having patents for surgical specimen collection kit; having stocks in Pfizer, Gilead Sciences, and Eli Lilly; serving as paid research consultant for the American Cancer Society, the Association of Community Cancer Centers, Genentech/Roche, Biodesix, Lungevity Foundation, National Cancer Institute, Tryptych Healthcare Partners, and AstraZeneca; and serving as founder for Oncobox Device, Inc. Dr. Smeltzer reports serving as paid research consultant for the Association of Community Cancer Centers. The remaining authors declare no conflict of interest.
Identification
Copyright
© 2022 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
