Differential eligibility of African American and European American lung cancer cases using LDCT screening guidelines

Abstract

Introduction: Lung cancer incidence and mortality is higher among African Americans compared with European Americans in the USA where screening guidelines are currently in place and based on age at diagnosis and smoking history. Given the different smoking patterns observed in these populations and the earlier age at which African Americans are diagnosed, it is possible that African Americans will be disproportionally excluded from screening programmes. Methods: We assessed the capture of African American and EA lung cancer cases using the National Lung Screening Trial, US Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility guidelines in a population of lung cancer cases diagnosed between 1998 and 2014 in the Baltimore region of Maryland (n=1658). Results: We found an absolute increase of 3.8% (relative increase: 11.5%) of EA lung cancer cases that fell within the eligible screening guidelines when compared with African Americans. This difference in proportions was not statistically significant (p=0.134). However, differences were more pronounced among women, where an absolute and relative difference of 4.2% and 13.6%, respectively, was observed (p=0.083). As more EA are likely to successfully quit smoking compared with African Americans, the inclusion of the time since quitting variable decreased the relative differences in eligibility. Conclusions: Current screening guidelines are projected to capture a higher proportion of EA lung cancer cases than African American cases; however, the differences are not statistically significant. Further studies are needed, especially among high-risk populations, to determine if racial differences in eligibility criteria for lung screening will lead to a widening of cancer health disparities.