Lung Cancer Screening Guidelines Exclude People Who May Need It Most

While national lung cancer screening guidelines exist with the goals of early detection and improving outcomes, recent research at the University of Illinois at Chicago (UIC) found that not everyone benefits equally from the guidelines established based on the National Lung Screening Trial (NLST) in 2011.

The researchers found that the trial that led to the guidelines — which recommend screening based on age and smoking history – did not include fair representation from all groups across the nation.

Crafting guidelines that fairly represent African Americans is particularly important, as they have the highest lung cancer mortality rate compared to other races, according to the researchers. “Screening programs tailored to high-risk patients of minority race/ethnicities could help to reduce this health disparity and save even more lives,” they wrote.

“What constitutes high-risk individuals is people who have more than a 30-pack a year smoking history — that’s a pack a day for 30 years, or two packs a day for 15 years. They also have to be between the ages of 55 to 88,” study author Lawrence Feldman, M.D., associate professor of clinical medicine at UIC, said in an interview with CURE.

In the retrospective analysis, published in JAMA Oncology, the researchers assessed the demographic characteristics, baseline low-dose computed tomography scan findings and detected lung cancers in an inner city, minority-based population at UIC (500 screenings compared with those of the National Lung Screening Trial (more than 26,000 screens).

Overall, the demographic characteristics from UIC and the National Lung Screening Trial were not similar. For example, there were more African American (69.6 percent vs. 4.5 percent) and Hispanic or Latino (10.6 percent vs. 1.8 percent) screens at the university compared with the trial.

The UIC group included a higher percentage of current smokers than the trial arm (72.8 percent vs. 48.1 percent). The researchers mentioned that individuals who are classified as low-income or having low education are more likely to smoke, which is the biggest risk factor for lung cancer.

“When you look at communities that are low-income or live in poverty, such as the South Side of Chicago, you’re going to find a lot more smokers, and maybe people who don’t access care as much, or who access car too late,” study author Mary Pasquinelli, MS, APRN, a nurse practitioner from the department of medicine at the University of Illinois at Chicago, said in an interview with CURE.

The UIC screens also resulted in a higher percentage of positive scans than the trial (24.6 percent versus 13.7 percent), and a higher percentage of diagnosed lung cancer cases (2.6 percent versus 1.1 percent).

Ultimately, the UIC group demonstrated a higher lung cancer detection rate (2.6 percent vs. 1.1 percent); and consistent with the goal of screening, both groups showed that more than half of lung cancer cases were detected at an early, curable stage.

“We’re looking to decrease health disparities, and when we compared our findings to the national trial, we found twice as many positive screens and twice as much cancer,” Pasquinelli said.

Moving forward, the researchers hope their findings can spark a change in lung cancer screening guidelines, ultimately improving outcomes.

“With our program on lung cancer screening, we’re really trying to get patients involved with primary screening for cancer, so we can find it early when it’s most curable,” Pasquinelli said. “We’re hoping that the future of lung cancer screening criteria will be keeping up.”