E5378. A Review of Race and Health Equity in Lung Cancer Screening Eligibility Criteria
Authors
Zoe Abraham;
Dalhousie University
Daria Manos;
Dalhousie University; QEII Health Sciences Centre
Background
Growing support for lung cancer screening is encouraging, given that lung cancer is the leading cause of cancer-related death, and that the probability of surviving lung cancer is significantly improved at early and asymptomatic stages. Randomized control trials have demonstrated that screening high-risk individuals for lung cancer with low-dose CT (LDCT) scans can reduce lung cancer mortality by at least 20–39%. However, these trials were not designed to determine lung cancer screening eligibility criteria. As a result, there is global heterogeneity in screening guidelines and risk prediction models, even when expert groups review the same evidence. The purpose of this exhibit is to review how and why eligibility criteria differ, with a focus on race and health equity.
Educational Goals / Teaching Points
The educational goals of this exhibit are to (1) compare eligibility criteria for organized lung cancer screening pilots and programs globally, including the United States, Canada, United Kingdom, Korea, and Japan; (2) review the benefits and risks of lung cancer screening to understand better the rationale for limiting eligibility; and (3) analyze lung cancer screening program eligibility criteria in the context of race and health equity.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The sensitivity, specificity, and positive/negative predictive values of lung cancer screening vary depending on the eligibility criteria. Globally, each jurisdiction that provides organized lung cancer screening has a unique approach to LDCT eligibility. Strict eligibility criteria can help limit the harms of lung cancer screening, but the effect on health equity is more complex. Lung cancer disproportionately affects Black and Indigenous individuals with higher incidence, higher death rates, and more advanced lung cancer stage at diagnosis. Although several countries now support lung cancer screening, access remains limited, especially for racialized populations. Attempts to improve racial disparities in lung cancer survival include altering the eligibility criteria for lung cancer screening, either by widening age and smoking history criteria or using risk models. The PLCOm2012 risk model incorporates several social determinants of health, including socioeconomic status and race. The United States Preventive Services Task Force revised their screening guidelines from a minimum of 30 pack-year history to > 20 pack-year history to improve equitable access to screening for Black smokers. Although limited data exists investigating lung cancer outcomes in racialized populations based on screening guidelines, evidence suggests that risk models may, in some ways, improve and, in other ways, worsen racial disparities in screening. Targeted educational campaigns, addressing geographic barriers, and screening based on individual social determinants of health may improve equitable access to lung cancer screening.
Conclusion
As lung cancer screening is implemented globally, it is important to understand how and why guidelines differ. We must also consider how these guidelines may improve or worsen racial disparities in lung cancer survival.
