Racial and ethnic disparities persist in lung cancer screening program
The United States Task Force on Preventive Services (USPSTF) recently expanded its eligibility criteria for lung cancer screening (LCS) with low-dose computed tomography, but these revisions may not have been enough to improve the racial and ethnic disparities of the LCS. In an original research article in the online edition of the journal Radiology, Mass General Hospital researchers found that although the new LDCT LCS guidelines increased eligibility overall (11% old vs. 14% new) and most racial groups (White: 14% to 15%; African Americans: 7% to 9%; Hispanics: 4% to 5%), African Americans and Hispanics nonetheless remain significantly less likely to be eligible for screening studies than whites.
In March, the USPSTF changed its lung cancer screening guidelines to recommend that former smokers start screening at age 50, rather than 55. The task force also reduced the number of years of smoking history that makes a person eligible for screening from 30 to 20 years (one pack per year = smoke one pack per day for one year; 1 pack = 20 cigarettes) . For example, the USPSTF recommends annual screening using an LDCT scanner for people aged 50 to 80 who are at high risk of lung cancer due to their history of smoking.
The researchers note that neither the previous guidelines nor the revised USPSTF LCS guidelines incorporate important risk factors for race, ethnicity, and socioeconomic status. African-American and Hispanic smokers become eligible for LCS when their risk of lung cancer is higher than that of whites, thus perpetuating inequalities in access to health care and preventing early intervention in these high-risk groups. The authors believe that the effectiveness of lung cancer screening in the diverse population of the United States would be increased if the LCS eligibility criteria included variables such as race and ethnicity, socio-demographic variables, and other predictors of lung cancer risk.
In a separate editorial in the same issue of Radiology, researchers from the Division of Cancer Treatment and Diagnosis and the Center to Reduce Cancer Health Disparities at the National Cancer Institute, recommend that more be done to address the deep disparities that continue to exist in eligibility for lung cancer screening.
Additionally, the Centers for Medicare and Medicaid Services (CMS) must also update their payment criteria. Currently, to be eligible for payment for screening, a Medicare beneficiary must:
- Be between 55 and 77 years old;
- Be asymptomatic (no signs or symptoms of lung cancer);
- Have a smoking history of at least 30 packs of years;
- Be a current smoker or have quit smoking within the past 15 years; and
- Receive a written order for LDCT lung cancer screening.
Additionally, CMS has yet to remove barriers to the performance of LDCT lung cancer screening services by independent diagnostic testing facilities (IDTFs).
To address racial and ethnic disparities, the revised recommendations of the US Preventive Services Task Force (USPSTF) lowered the thresholds for lung cancer screening (LCS). Using cross-sectional survey data from 20 states, African American respondents (adjusted odds ratio [OR]: 0.39; 95% CI: 0.32, 0.47; P
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