This was the first study to evaluate the impact of the introduction of lung cancer screening in the U.S. on population-level lung cancer stage shift and survival. We found that the introduction of low-dose computed tomography lung cancer screening in the U.S. was associated with a significant shift to earlier stages of lung cancer identified and an estimated 10,000 lives saved. The study was cited in the European Union’s, “Cancer Screening Recommendations,” and the World Economic Forum’s, “Urgent, Coordinated Global Action on Lung Cancer,” and was also featured in the NEJM Group Lung Cancer Update (August 2022). This study, which demonstrates that lung cancer screening is leading to a beneficial lung cancer stage shift and a decrease in mortality at the population level, is arguably the most important study (outside of the two large scale randomized trials, NLST and NELSON) that is being used to support national and international guidelines on lung cancer screening.
The new 2021 US Preventive Services Task Force (USPSTF) lung cancer screening guidelines increased the number of people eligible for screening; however, the impact of the changes made in the new USPSTF guidelines on Black individuals was unclear. Using data from the Black Women’s Health Study, an epidemiological cohort study of over 58,000 Black women, we evaluated the screening eligibility among Black women under the new 2021 USPSTF guidelines and found that ~60% of Black women lung cancer patients would have been ineligible for screening. The results of this study were presented to the Centers of Medicaid and Medicare Services (CMS) to support removing the “15-year since quitting criteria” from the lung cancer screening guidelines; a decision from CMS is pending. This study will also likely be taken into strong consideration by the USPSTF when they develop the next lung cancer screening guidelines.
In this analysis of patients with lung cancer in the Southern Community Cohort Study, there remained a large gap in lung cancer screening eligibility between Black and White men and women under the 2021 US Preventive Services Task Force guideline. Only 50% of Black women and 63% of Black men diagnosed with lung cancer would have qualified for screening compared to 75% of White women and 74% of White men. The primary reason for ineligibility among Black patients with lung cancer was having too few smoking pack-years.
In this analysis of two large cohort studies, use of a 20-pack-year smoking history cutoff as a selection criterion for lung cancer screening in the current US Preventive Services Task Force (USPSTF) guideline excluded many individuals diagnosed with lung cancer and led to a marked racial disparity in screening eligibility between Black versus white individuals. Revising the current USPSTF guideline to include a 20-year smoking duration cutoff (instead of a 20-pack-year smoking history cutoff) increased the proportion of patients with lung cancer who would qualify for screening and eliminated the racial disparity in screening eligibility.