Despite decreasing overall lung cancer mortality rates in the U.S., the racial disparity in deaths from the disease continues to widen. Tailoring CT lung cancer screening programs to inner-city, high-risk minority smokers may help bridge the gap, say Illinois researchers in a letter published online August 2 in JAMA Oncology.
Researchers from the University of Illinois at Chicago found that minority participants in their inner-city CT lung cancer screening program had rates of positive CT exams and lung cancer detection that were twice that of the landmark National Lung Screening Trial (NLST).
The group, led by Mary Pasquinelli, examined the demographics, baseline findings, and lung cancer detection rates for a minority population that underwent CT screening between September 2015 and December 2017 at the University of Illinois at Chicago. The researchers used the same criteria as the NLST to determine participant eligibility and compared the first 500 baseline CT exams in their study to the 26,722 baseline CT exams performed in NLST.
Compared with the NLST, the inner-city screening program included a markedly different racial and ethnic composition. The vast majority of the participants in the study were black, whereas more than 90% of those screened in the NLST were white; the proportion of Latinos who underwent screening through the program was more than five times that of the NLST. In addition, a considerably higher percentage of these individuals were current smokers than those in the NLST.
Pasquinelli and colleagues examined the CT scans using the American College of Radiology Lung-RADS guidelines for risk stratification and standardization of lung nodules. Their analysis revealed that this cohort of mostly minorities had approximately two times the percentage of both positive CT lung cancer screening exams (Lung-RADS class 3 or 4) and lung cancer diagnoses than that of the NLST.
| NLST vs. inner-city CT lung cancer screening program | ||
| NLST | Inner-city, minority-based CT screening program | |
| % of African-Americans in screening population | 4.5% | 69.6% |
| % of Latinos in screening population | 1.8% | 10.6% |
| % of current smokers | 48.1% | 72.8% |
| Positive CT screening exam | 13.7% | 24.6% |
| Lung cancer detection rate | 1.1% | 2.6% |
"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," the authors wrote.
The results are also consistent with the notion that factoring in a more personalized assessment of lung cancer risk into screening criteria may be more effective than referring to age and smoking status alone, they concluded. Refining risk-based guidelines could ultimately improve the beneficial results of CT lung cancer screening.
