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Original Investigation
January 13, 2022

Comparison Between the 2021 USPSTF Lung Cancer Screening Criteria and Other Lung Cancer Screening Criteria for Racial Disparity in Eligibility

Author Affiliations
  • 1Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan
  • 2Karmanos Cancer Institute, Detroit, Michigan
  • 3Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
  • 4Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
  • 5Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
JAMA Oncol. Published online January 13, 2022. doi:10.1001/jamaoncol.2021.6720
Key Points

Question  Do the sensitivity and specificity of the 2021 US Preventive Services Task Force (USPSTF) lung cancer screening eligibility criteria differ by race from other established lung cancer screening criteria?

Findings  This study of 912 patients with lung cancer and 1457 controls without lung cancer found that the sensitivity of the 2021 USPSTF criteria was better than that of the 2013 USPSTF criteria but worse than that of the 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012), and the specificity of the 2021 USPSTF criteria was worse than that of the 2013 USPSTF criteria and PLCOm2012. While the 2013 USPSTF criteria selected more White cases and excluded more African American cases, there was no racial disparity in sensitivity or specificity with the 2021 USPSTF criteria and PLCOm2012.

Meaning  This study suggests that the 2021 USPSTF guideline changes improve on earlier, fixed screening criteria for lung cancer, broadening eligibility and reducing racial disparity in access to screening.

Abstract

Importance  In 2021, the US Preventive Services Task Force (USPSTF) broadened its age and smoking pack-year requirement for lung cancer screening.

Objectives  To compare the 2021 USPSTF lung cancer screening criteria with other lung cancer screening criteria and evaluate whether the sensitivity and specificity of these criteria differ by race.

Design, Setting, and Participants  This study included 912 patients with lung cancer and 1457 controls without lung cancer enrolled in an epidemiology study (INHALE [Inflammation, Health, Ancestry, and Lung Epidemiology]) in the Detroit metropolitan area between May 15, 2012, and March 31, 2018. Patients with lung cancer and controls were 21 to 89 years of age; patients with lung cancer who were never smokers and controls who were never smokers were not included in these analyses. Statistical analysis was performed from August 31, 2020, to April 13, 2021.

Main Outcomes and Measures  The study assessed whether patients with lung cancer and controls would have qualified for lung cancer screening using the 2013 USPSTF, 2021 USPSTF, and 2012 modification of the model from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCOm2012) screening criteria. Sensitivity was defined as the percentage of patients with lung cancer who qualified for screening, while specificity was defined as the percentage of controls who did not qualify for lung cancer screening.

Results  Participants included 912 patients with a lung cancer diagnosis (493 women [54%]; mean [SD] age, 63.7 [9.5] years) and 1457 control participants without lung cancer at enrollment (795 women [55%]; mean [SD] age, 60.4 [9.6] years). With the use of 2021 USPSTF criteria, 590 patients with lung cancer (65%) were eligible for screening compared with 619 patients (68%) per the PLCOm2012 criteria and 445 patients (49%) per the 2013 USPSTF criteria. With the use of 2013 USPSTF criteria, significantly more White patients than African American patients with lung cancer (324 of 625 [52%] vs 121 of 287 [42%]) would have been eligible for screening. This racial disparity was absent when using 2021 USPSTF criteria (408 of 625 [65%] White patients vs 182 of 287 [63%] African American patients) and PLCOm2012 criteria (427 of 625 [68%] White patients vs 192 of 287 [67%] African American patients). The 2013 USPSTF criteria excluded 950 control participants (65%), while the PLCOm2012 criteria excluded 843 control participants (58%), and the 2021 USPSTF criteria excluded 709 control participants (49%). The 2013 USPSTF criteria excluded fewer White control participants than African American control participants (514 of 838 [61%] vs 436 of 619 [70%]). This racial disparity is again absent when using 2021 USPSTF criteria (401 of 838 [48%] White patients vs 308 of 619 [50%] African American patients) and PLCOm2012 guidelines (475 of 838 [57%] White patients vs 368 of 619 [60%] African American patients).

Conclusions and Relevance  This study suggests that the USPSTF 2021 guideline changes improve on earlier, fixed screening criteria for lung cancer, broadening eligibility and reducing the racial disparity in access to screening.

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