Potential Disparities by Sex and Race or Ethnicity in Lung Cancer Screening Eligibility Rates

Elsevier, Chest, Volume 160, July 2021
Pinsky P.F., Lau Y.K., Doubeni C.A.
Background: Criteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations. Research Question: What are the eligibility rates for low-dose CT scan screening according to sex and race or ethnicity and how do these rates relate to corresponding lung cancer incidence rates? Study Design and Methods: This was a cross-sectional study using data from the 2015 National Health Interview Survey adult and cancer control supplement files. In addition to eligibility rates, the ratio of the eligibility rate to the lung cancer incidence rate in a given population group (eligibility to incidence [E-I] ratio) also was determined. Guidelines assessed were: Centers for Medicare and Medicaid Services, National Comprehensive Cancer Network, and US Preventive Services Task Force current or with expansion of age and smoking or quit thresholds. We also assessed a risk model (PLCOM2012 risk model). Results: Total numbers eligible based on current guidelines ranged from 8.3 to 13.3 million, representing 8.3% to 13.4% of the US population 50 to 80 years of age, and up to 17.5 million with expanded criteria. Overall eligibility rates on average were about 10 percentage points higher for men than women. For both men and women, and both overall and among ever smokers, non-Hispanic Whites had the highest eligibility rates across all guidelines, followed generally by non-Hispanic Blacks, and then Asians and Hispanics. Among both men and women, non-Hispanic Whites had the highest E-I ratios across all guidelines; non-Hispanic Black men had higher lung cancer incidence, but 30% to 50% lower E-I ratios, than non-Hispanic White men. Interpretation: Screening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.