Association of Inclusion of More Black Individuals in Lung Cancer Screening With Reduced Mortality

Prosper, Ashley; Inoue, Kosuke; Brown, Kathleen; Bui, Alex A. T.; Aberle, Denise R.; Hsu, William

doi:10.1001/jamanetworkopen.2021.19629

Cited by 21 publications

(16 citation statements)

References 24 publications

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“…The number needed to screen to prevent one lung cancer death (NNS) was 303 in extended follow-up, similar to the original reported NNS of 320 [ 22 ]. A cohort study as a secondary analysis of NLST data with the inclusion of more black individuals showed a greater mortality reduction due to lung cancer (black individuals: Hazard ratio [HR] 0.82; 95% CI: 0.72-0.92; versus the whole NLST cohort: HR 0.84; 95% CI: 0.76-0.96), hence stressing the need of access to lung cancer screening for black populations with habits of smoking [ 23 ].…”

Section: Reviewmentioning

confidence: 99%

The 50-Year Journey of Lung Cancer Screening: A Narrative Review

Parekh¹,

Deokar²,

Verma³

et al. 2022

Cureus

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Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms "low dose computed tomography" and "lung cancer screening" for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. "LDCT screening" can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.

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Section: Reviewmentioning

confidence: 99%

The 50-Year Journey of Lung Cancer Screening: A Narrative Review

Parekh¹,

Deokar²,

Verma³

et al. 2022

Cureus

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“… 5 , 6 Paradoxically, lung cancer screening threatens to exacerbate preexisting racial and geographic disparities in lung cancer mortality. 7 , 8 , 9 , 10 , 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

“…5,6 Paradoxically, lung cancer screening threatens to exacerbate preexisting racial and geographic disparities in lung cancer mortality. [7][8][9][10][11][12] Persons at greatest risk for lung cancer, such as the less well-educated, rural dwellers, and the socioeconomically disadvantaged, are also least likely to access preventive care. [13][14][15][16][17] Such persons often seek care in settings ill-equipped for preventive care.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Lung Cancer Risk Among Persons Undergoing Screening or Guideline-Concordant Monitoring of Lung Nodules in the Mississippi Delta

Osarogiagbon¹,

Liao²,

Faris³

et al. 2023

JAMA Netw Open

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ImportanceGuideline-concordant management of lung nodules promotes early lung cancer diagnosis, but the lung cancer risk profile of persons with incidentally detected lung nodules differs from that of screening-eligible persons.ObjectiveTo compare lung cancer diagnosis hazard between participants receiving low-dose computed tomography screening (LDCT cohort) and those in a lung nodule program (LNP cohort).Design, Setting, and ParticipantsThis prospective cohort study included LDCT vs LNP enrollees from January 1, 2015, to December 31, 2021, who were seen in a community health care system. Participants were prospectively identified, data were abstracted from clinical records, and survival was updated at 6-month intervals. The LDCT cohort was stratified by Lung CT Screening Reporting and Data System as having no potentially malignant lesions (Lung-RADS 1-2 cohort) vs those with potentially malignant lesions (Lung-RADS 3-4 cohort), and the LNP cohort was stratified by smoking history into screening-eligible vs screening-ineligible groups. Participants with prior lung cancer, younger than 50 years or older than 80 years, and lacking a baseline Lung-RADS score (LDCT cohort only) were excluded. Participants were followed up to January 1, 2022.Main Outcomes and MeasuresComparative cumulative rates of lung cancer diagnosis and patient, nodule, and lung cancer characteristics between programs, using LDCT as a reference.ResultsThere were 6684 participants in the LDCT cohort (mean [SD] age, 65.05 [6.11] years; 3375 men [50.49%]; 5774 [86.39%] in the Lung-RADS 1-2 and 910 [13.61%] in the Lung-RADS 3-4 cohorts) and 12 645 in the LNP cohort (mean [SD] age, 65.42 [8.33] years; 6856 women [54.22%]; 2497 [19.75%] screening eligible and 10 148 [80.25%] screening ineligible). Black participants constituted 1244 (18.61%) of the LDCT cohort, 492 (19.70%) of the screening-eligible LNP cohort, and 2914 (28.72%) of the screening-ineligible LNP cohort (P &lt; .001). The median lesion size was 4 (IQR, 2-6) mm for the LDCT cohort (3 [IQR, 2-4] mm for Lung-RADS 1-2 and 9 [IQR, 6-15] mm for Lung-RADS 3-4 cohorts), 9 (IQR, 6-16) mm for the screening-eligible LNP cohort, and 7 (IQR, 5-11) mm for the screening-ineligible LNP cohort. In the LDCT cohort, lung cancer was diagnosed in 80 participants (1.44%) in the Lung-RADS 1-2 cohort and 162 (17.80%) in the Lung-RADS 3-4 cohort; in the LNP cohort, it was diagnosed in 531 (21.27%) in the screening-eligible cohort and 447 (4.40%) in the screening-ineligible cohort. Compared with Lung-RADS 1-2, the fully adjusted hazard ratios (aHRs) were 16.2 (95% CI, 12.7-20.6) for the screening-eligible cohort and 3.8 (95% CI, 3.0-5.0) for the screening-ineligible cohort; compared with Lung-RADS 3-4, the aHRs were 1.2 (95% CI, 1.0-1.5) and 0.3 (95% CI, 0.2-0.4), respectively. The stage of lung cancer was I to II in 156 of 242 patients (64.46%) in the LDCT cohort, 276 of 531 (52.00%) in the screening-eligible LNP cohort, and 253 of 447 (56.60%) in the screening-ineligible LNP cohort.Conclusions and RelevanceIn this cohort study, the cumulative lung cancer diagnosis hazard of screening-age persons enrolled in the LNP was higher than that in a screening cohort, irrespective of smoking history. The LNP provided access to early detection for a higher proportion of Black persons.

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“… 3 , 8 Screening for lung cancer starting at an earlier age and a lower pack-year history should reduce racial disparities in screening eligibility, in particular for Blacks, who smoke fewer cigarettes per day (CPD) yet have a higher risk of lung cancer. 9 , 10 , 11 The new eligibility criteria also increased the proportion of LCS-eligible women who smoke fewer CPD on average or have lower pack-years. 12 …”

Section: Introductionmentioning

confidence: 99%