Racial disparities in lung cancer screening risk factors in an underrepresented safety-net screening population
OA Version
Citation
Abstract
BACKGROUND: The USPSTF (United States Preventive Service Task Force) criteria for lung cancer screening focuses on smoking status and age as the only relevant risk factors for lung cancer screening and does not consider potential racial disparities. Several other risk factors may potentially be predictive of lung cancer. The purpose of this study was to assess other risk factors and to evaluate any racial disparities within these risk factors to create a more comprehensive screening tool.
METHODS: We performed a retrospective chart review of patients who received LDCT screening for lung cancer between 3/1/2015 and 12/31/2019 at Boston Medical Center. Patient demographics and medical histories were collected. A bivariate logistic regression analysis was used to evaluate predictors of lung cancer. A Breslow test was performed to observe if race was an effect modifier.
RESULTS: A total of 2847 patient charts were reviewed. For white patients, having a history of severe emphysema (adjusted OR 6.25; CI 95% 2.47-15.80), diagnosed with COPD (Chronic Obstructive Pulmonary Disease) (adjusted OR 1.32; CI 95% 0.76-2.30), a family history of cancer (adjusted OR 3.54; CI 95% 2.17-5.77) and a 50+ pack-year smoking history (adjusted OR 2.47; CI 95% 1.48-4.12) are all significantly associated with developing Lung-RADS4. For black patients, having a history of moderate (adjusted OR 3.29; CI 95% 1.44-7.49) and severe emphysema (adjusted OR 3.66; CI 95% 1.39-9.60), and age older than 65 years (adjusted OR 1.67; CI 95% 1.01-2.75) are significantly associated with Lung-RADS4.
CONCLUSION: Current USPSTF screening criteria can be improved by incorporating all relevant risk factors and creating non-biased criteria that account for racial disparities.