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Comment & Response
November 7, 2019

Defining Equity in Eligibility for Cancer Screening—Reply

Author Affiliations
  • 1Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
  • 2Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Oncol. Published online November 7, 2019. doi:https://doi.org/10.1001/jamaoncol.2019.4604

In Reply We thank Robbins and Johansson for their comments on our proposed changes to the lung cancer screening guidelines for African American individuals.1 The question of equity in lung cancer screening is an important one; access, effectiveness, harms, and benefits need to be carefully considered and ultimately balanced as best possible. Robbins and Johansson are concerned that African American individuals with a 20- to 29-pack-year history of smoking do not have sufficient risk to make screening a net benefit. However, the risk of lung cancer among African American individuals who smoke lower amounts of cigarettes is known to equal or exceed risks among white individuals smoking higher amounts.2,3 This pattern is observed in the Southern Community Cohort Study, in which the absolute risk of lung cancer among African American individuals with a 20- to 29-pack-year history of smoking was equal to (for current smokers) or exceeded (for former smokers) the risk of lung cancer among white individuals with a 30- to 39-pack-year history of smoking (W.J.B., unpublished data, August 2019).

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