Racial Disparities in Lung Cancer Screening Persist | MyLungCancerTeam

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Racial Disparities in Lung Cancer Screening Persist

Medically reviewed by Todd Gersten, M.D.
Written by Maureen McNulty
Posted on November 23, 2021

  • A study has found that newly revised lung cancer screening guidelines in the U.S. may not allow equal access to screening across racial and ethnic groups.
  • African Americans and Hispanics are still less likely to qualify for screenings than white people, based on the new guidelines.
  • Screening eligibility is based on age and smoking history. Because some ethnic groups tend to develop lung cancer at younger ages and with less cigarette exposure than others, research suggests a need to tailor the guidelines to best serve all populations.

Recent research shows unequal access to lung cancer screening in the U.S. for people of different ethnicities. The U.S. Preventive Services Task Force (USPSTF) recently widened the eligibility criteria for lung cancer screenings. However, a study published Sept. 21 in the journal Radiology found African Americans and Hispanics are still less likely to qualify for screenings than white people.

Experts recommend people with a history of smoking undergo regular screening to look for lung cancer. Lung cancer screening has been shown to reduce lung cancer deaths among heavy smokers by 20 percent.

Lung Cancer Screening Eligibility

The USPSTF decides which groups of people should undergo cancer screening. These recommendations help determine whether health insurance, Medicare, and Medicaid will pay for the lung cancer screening tests.

Initially, the USPSTF recommended lung cancer screening for people between the ages of 55 and 80 who have a smoking history of at least 30 “pack years.” A “pack year” describes how much a person has smoked. If a person has a smoking history of one pack year, this means that they have smoked on average one pack of cigarettes per day for one year. The USPSTF recently changed its recommendations so that more people will qualify for screening. Now, people aged 50 to 80 with a smoking history of just 20 pack years are eligible.

Under the old USPSTF guidelines, white people were often more likely to qualify for lung cancer screening than people of other races and ethnicities. However, people of color are more likely to develop lung cancer after smoking for fewer pack years. By the time African American and Hispanic who smoke are eligible for screening, their risk of developing lung cancer is already higher compared to white people with a similar smoking history. This means that some people in racial minority groups need increased access to lung cancer screening.

Lung Cancer Screening and Racial and Ethnic Disparities

The authors of the new study wanted to determine whether the USPSTF’s updated guidelines, which lowered the number of pack years needed to qualify for a screening, provided better access to lung cancer screening for people of color. The researchers collected data from a 2019 survey in which people around the U.S. answered questions about their health and habits. They calculated whether individuals from the study would be eligible for lung cancer screening based on the new guidelines.

The researchers found that overall, more Americans can now undergo lung cancer screening than before. Under previous guidelines, 11 percent of the people in the study were eligible for screening, while the new guidelines provided access for 14 percent of people.

However, the study authors found that the USPSTF’s new guidelines did not equalize access to lung cancer screening. Under the new guidelines, the percentage of people in each racial or ethnic group who qualified for screening were as follows:

  • American Indian — 21 percent
  • White — 15 percent
  • African American — 9 percent
  • Hispanic — 5 percent
  • Asian or Pacific Islander — 5 percent
  • Other — 18 percent

These results show that some racial and ethnic minority groups are still underrepresented in screening test eligibility. Additional work is needed to ensure more equal access. The study authors concluded, “The revised U.S. Preventive Services Task Force guidelines (version 2.0) may perpetuate lung cancer disparities, as racial and ethnic minority groups are still less likely to be eligible for lung cancer screening.”

Other researchers have also raised concerns that the updated guidelines don’t go far enough in providing access to life-saving screening tests for those who need it. For example, one past study also found that women who might need lung cancer screening were less likely to qualify, in addition to Black and Hispanic people who smoke. Another recent study found that that including more Black people in National Lung Screening Trial would reduce deaths related to lung cancer.

Posted on November 23, 2021
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Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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