Guidelines for lung cancer screening undercount African Americans.

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African Americans are undercounted by the existing public health screening guidelines for lung cancer according to a study in the Journal of Thoracic Oncology.1 Current US Preventive Services Task Force (USPSTF) and Centers for Medicare and Medicaid Services guidelines were developed on the basis of results from the National Lung Screening Trial. They recommend low-dose computed tomography screening for individuals aged 55 to 80 years who have a cigarette smoking history of 30 pack-years or longer and for people aged 55 to 77 years who smoked previously and have quit within the past 15 years. However, these guidelines are undercounting African American individuals, who are more likely to start smoking at a later age, smoke fewer cigarettes per day, and have a longer duration of smoking; are less likely to quit; and tend to be diagnosed at an earlier age. A previous Southern Community Cohort study of 48,364 ever smokers demonstrated that a smaller percentage of African American individuals would have met the current USPSTF criteria in comparison with Whites (17% vs 31%).2 Furthermore, after adjustments for both age and smoking history, African American ever smokers are at higher risk for lung cancer than White ever smokers. In the Journal of Thoracic Oncology follow-up study, researchers from the University of Illinois at Chicago conducted a retrospective analysis of 1050 patients with thoracic cancer in their cancer registry. Scientists assessed the cohort to determine whether each case would have been eligible by USPSTF criteria for screening based on age, packyears (average packages of 20 cigarettes smoked per day times years smoked), and quit time. The cohort included Whites, African Americans, Hispanics, and Asians and a small number of individuals from other ethnicities. The analysis used data collected from the PLCOm2012 lung cancer risk prediction model. The model incorporates 11 predictors, including sociodemographics, medical history, and 4 smoking exposure variables. Compared with USPSTF criteria, this model had increased sensitivity for lung cancer risk in the African American cohort and for White ever smokers and thus reduced disparities. Of the 64 African American ever smokers who were ineligible according to USPSTF criteria because they were younger than 55 years, 23.4% would have qualified for screening by the PLCOm2012 model with a risk threshold of 1.7%. Of the 53 African American ever smokers who were ineligible according to USPSTF criteria because they had quit smoking more than 15 years ago, 49.1% would have qualified with the PLCOm2012 model. Lastly, of the 193 African American ever smokers who were ineligible according to USPSTF criteria because their smoking history was less than 30 pack-years, 40.4% would have qualified with the PLCOm2012 model. As a result, researchers encourage broader use of this model in racially diverse populations to help to reduce disparities in both lung cancer screenings and outcomes.