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Lung cancer screening skewed toward white individuals may increase racial disparities

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August 2, 2018

Mary M. Pasquinelli

Lung cancer screening within an urban population showed a higher incidence of positive lung cancer detection than the National Lung Screening Trial, which included a predominantly white population, according to findings from a retrospective analysis.

Thus, a more-detailed assessment of individual risk for lung cancer may be more effective than focusing only on age and smoking status criteria, according to the researchers.

“Our study is important for patients so that people at high risk for lung cancer know about their options for lung cancer screening, particularly among minority populations that may be at higher risk for dying of lung cancer compared with white patients,” Mary M. Pasquinelli, MS, APRN, a 2018 doctor of nursing practice candidate and director of the lung cancer screening program at University of Illinois College of Medicine at Chicago, told HemOnc Today.

The overall incidence and mortality from lung cancer has decreased over time. However, African-Americans have the highest mortality rates from lung cancer compared with other races, suggesting racial disparities. Screening programs tailored to high-risk patients of minority races or ethnicities could reduce disparities.

Pasquinelli and colleagues compared data from 500 baseline low-dose CT screens (median age, 62.8 year) performed at University of Illinois at Chicago (UIC) with 26,722 baseline low-dose CT screens (median age, 61.4 years) performed within the National Lung Screening Trial (NLST).

Investigators compared findings via Lung-RADS criteria — a commonly used method of risk stratifying and standardizing low-dose CT findings — established by the American College of Radiology in 2015.

The UIC cohort comprised more African-American individuals (69.6% vs. 4.5%) and Hispanic or Latino individuals (10.6% vs. 1.8%; P < .001 for both) than the NLST, as well as a greater proportion of current smokers (72.8% vs. 48.1%).

Researchers observed a different outcome distribution of Lung-RADS categories between the UIC and NLST cohorts (P < .001).

The number of positive low-dose CT screens appeared almost double among the UIC cohort compared with the NLST cohort (24.6% vs. 13.7%). Lung cancer detection rate was 2.6% in the UIC cohort compared with 1.1% in the NLST cohort (P = .002).

“These real-world differences are in accordance with a secondary analysis from NLST that showed that reduction in lung cancer mortality was greatest among African-American participants,” Pasquinelli and colleagues wrote.

“The magnitude of the disparity in lung cancer mortality between African-American and

white individuals has been widening,” they added. “Screening that is skewed toward the white population could paradoxically increase racial disparities in lung cancer outcomes.”

Both cohorts had more than 50% of lung cancer cases detected at stage I curable stage, which was consistent with screening goals.

Limitations of the study included the use of a retrospective design and including patients only after initial screening, whereas the NLST screened patients annually for 3 years and had a prospective study design.

“More people’s lives could be saved by screening individuals at high risk for lung cancer if they get screened with low-dose CT scan by detecting this disease at an earlier stage,” Pasquinelli said. “More community education directed toward people at risk and their providers is needed.” – by Melinda Stevens

For more information

Mary M. Pasquinelli , MS, APRN, can be reached at Department of Medicine, University of Illinois at Chicago, 840 S. Wood St., Room 920N, CSB (MC 719), Chicago, IL 60612; email:

Disclosures: The authors report no relevant financial disclosures.

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