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Central Surgical Association

49th Annual Meeting

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Race Associated with Lower Eligibility For Screening Using 2021 US Preventive Services Task Force Recommendations among Lung Cancer Patients at an Urban Safety Net Hospital
Anqi Liu1, Noreen Siddiqi1, Umit Tapan3, Kimberly Mak4, Katrina A. Steiling5, Kei Suzuki2
1Boston University School of Medicine, Boston, Massachusetts, United States, 2Surgery - Division of Thoracic Surgery, INOVA, Falls Church, Virginia, United States, 3Internal Medicine - Hematology & Oncology, Boston Medical Center, Boston, Massachusetts, United States, 4Radiation Oncology, Boston Medical Center, Boston, Massachusetts, United States, 5Medicine - Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts, United States

Objective: In 2013, the US Preventive Services Task Force (USPSTF) recommended lung cancer screening (LCS) using annual low dose computed tomography (LDCT) for adults aged 55 to 80 years with a 30 pack-year smoking history. However, these criteria were derived from clinical trials of predominantly White men, and reduced screening rates have been found in Black adults. These criteria were revised in 2021 to address disparities in screening eligibility. We evaluated whether the revised USPSTF criteria reduced disparities in LCS eligibility among racially diverse patients diagnosed with lung cancer.

Methods: We conducted a retrospective chart review of patients at an urban safety net hospital diagnosed with a primary lung malignancy between 2015-2020. Demographic data, smoking history, and receival of LCS was recorded. Race was categorized as White, Black, or Other based on self-report. LCS eligibility was determined based on smoking status, pack years, and age prior to cancer diagnosis. Patients with missing smoking history data were excluded from analysis. Chi-squared tests of independence were used to evaluate differences in LCS eligibility among demographic variables including race, gender, ethnicity, education level, and insurance type for both the 2013 and 2021 USPSTF criteria. We also examined whether there was a difference in LCS rates among those eligible under the 2013 criteria.

Results: Among 687 lung cancer patients (46% female, mean age [SD], 66 [10] years), 51% were White, 39% were Black, and 10% were Other. Using 2013 USPSTF guidelines, White adults (51%) were more likely to be eligible than Black (33%) and Other patients (29%) (p<0.0001). Under the revised criteria, eligibility rates increased to 62% among White, 49% among Black, and 41% among Other patients. There was no difference in increase in eligibility between each race (p=0.23). Despite the increase, White patients were still more likely to be eligible than Black and Other adults (p=0.0006). Gender, ethnicity, education, and insurance status were not associated with differential screening eligibility. Among patients eligible for screening, there was no significant difference in screening rates between White (20%), Black (24%), and Other adults (33%) (p=0.43).

Conclusion: While the revised 2021 USPSTF LCS criteria increase LCS eligibility for Black and non-White patients, it may not eliminate disparities in LCS eligibility among non-White patients who go on to be diagnosed with primary lung cancer. Limitations include the retrospective nature of the study and limited sample. Further studies are needed to investigate potential specialized eligibility models for non-White patient groups or consider additional factors beyond smoking history to further reduce bias in LCS eligibility.

Figure 1. Using 2013 USPSTF guidelines, White adults (51%) were more likely to be eligible than Black (33%) and Other patients (29%) (p<0.0001). Despite the increase in eligibility rates using 2021 USPSTF guidelines, White patients (62%) were still more likely to be eligible than Black (49%) and Other adults (41%) (p=0.0006).


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