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Publications

Journal Article Ahead of print

PubMed: 41397256 DOI: 10.7326/ANNALS-25-00464

Eligibility and Prognostic Performance of Smoking Duration-Based Versus Pack-Year-Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups.

Ann Intern Med

Authors: Chloe C Su, Victoria Y Ding, Kevin Ten Haaf, Julie T Wu, Neal D Freedman, Leah M Backhus, Ann N Leung, Natalie S Lui, Christopher A Haiman, Sung-Shim Lani Park, Joel W Neal, Rafael Meza, Martin C Tammemägi, Iona Cheng, Loïc Le Marchand, Heather A Wakelee, Eunji Choi, Summer S Han

Affiliations

  • Department of Epidemiology and Population Health, Stanford University School of Medicine, and Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California (C.C.S.).
  • Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California (V.Y.D.).
  • Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (K.t.H.).
  • Veterans Affairs Palo Alto Healthcare System, Palo Alto, California (J.T.W.).
  • Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (N.D.F.).
  • Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California (L.M.B. N.S.L.).
  • Department of Radiology, Stanford University School of Medicine, Stanford, California (A.N.L.).
  • Center for Genetic Epidemiology, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California (C.A.H.).
  • Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, Hawai'i (S.-S.L.P. L.L.M.).
  • Division of Oncology, Department of Medicine, Stanford University School of Medicine, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California (J.W.N. H.A.W.).
  • Department of Integrative Oncology, BC Cancer Research Institute, and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (R.M.).
  • Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada (M.C.T.).
  • Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California (I.C.).
  • Department of Population Health Sciences, Weill Cornell Medicine, New York, New York (E.C.).
  • Department of Epidemiology and Population Health, Stanford University School of Medicine; Quantitative Sciences Unit, Stanford University School of Medicine; Stanford Cancer Institute, Stanford University School of Medicine; and Department of Neurosurgery, Stanford University School of Medicine, Stanford, California (S.S.H.).

Abstract

BACKGROUND

The U.S. Preventive Services Task Force expanded lung cancer (LC) screening eligibility in 2021 (USPSTF-2021) by decreasing the minimum number of smoking pack-years from 30 to 20. Underrepresented minorities still experience disparities in screening eligibility.

OBJECTIVE

To evaluate screening eligibility and prognostic performance of alternative smoking duration-based criteria versus USPSTF-2021 (primary outcome) and risk-based screening using the recalibrated Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012 update) model (secondary outcome) across diverse racial and ethnic groups.

DESIGN

Prospective, population-based Multiethnic Cohort linked to SEER (Surveillance, Epidemiology, and End Results) registries.

SETTING

California and Hawai'i, with recruitment from 1993 to 1996.

PARTICIPANTS

105 261 adults aged 45 to 75 years with a history of smoking.

MEASUREMENTS

Hypothetical eligibility and prognostic performance (sensitivity and specificity) in detecting 6-year LC.

RESULTS

Under USPSTF-2021, 24.0% of the cohort would be eligible for screening; a 30-year smoking duration yielded the closest eligibility rate (27.5%). Compared with USPSTF-2021, the 30-year duration criteria would reduce eligibility gaps across all races relative to Whites, most notably in African Americans (30.4% vs. 28.8% for Whites under duration-based; 21.4% vs. 30.2% for Whites under USPSTF-2021) and Latinos (25.1% vs. 28.8% for Whites under duration-based; 15.7% vs. 30.2% for Whites under USPSTF-2021). Prognostic sensitivity to identify LC within 6 years increased across all races under the 30-year duration criteria, although specificity decreased commensurately. At matched overall eligibility (27.5%), a risk-based PLCOm2012 update 6-year threshold of 1.1% improved both sensitivity and specificity in the overall cohort. However, it widened the eligibility gap between Latinos and Whites (14.4% vs. 31.3%) and demonstrated lower sensitivity in Latinos than duration-based criteria (59.7% vs. 69.8%).

LIMITATIONS

Cohort geography and enrollment period may limit generalizability. Overdiagnosis was not measured.

CONCLUSION

Compared with USPSTF-2021, the 30-year duration-based criteria could reduce the eligibility gaps among African Americans and Latinos relative to Whites while improving 6-year LC detection sensitivity across all races.

PRIMARY FUNDING SOURCE

National Institutes of Health.

MeSH

Lung, Internal Medicine, Neoplasms, Lung Neoplasms, Smoking, Sensitivity And Specificity