A new study suggests that basing lung cancer screenings on how long a person has smoked, rather than the intensity of their smoking, could reduce racial disparities in early detection. The research, published in Annals of Internal Medicine, found that this approach improved six-year lung cancer detection across all racial groups, particularly among African Americans and Latinos.
Currently, the United States Preventive Services Task Force (USPSTF) recommends screening adults with a 20 pack-year smoking history starting at age 50. While these guidelines expanded eligibility and aimed to reduce racial disparities, gaps remain because pack-years focus on smoking intensity rather than duration.
Researchers from Stanford University School of Medicine analyzed data from 105,261 adults aged 45–75 with a history of smoking, enrolled in the Multiethnic Cohort Study in California and Hawaii from 1993 to 1996. They compared traditional USPSTF criteria with screening based on smoking duration and a risk-based model known as PLCOm2012update (from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial).
The study found that only 24% of participants met the USPSTF-2021 screening criteria, with African Americans and Latinos less likely to qualify compared to Whites. Using smoking duration as a criterion increased eligibility for African Americans and Latinos while keeping overall eligibility roughly the same. Detection sensitivity improved under this approach, although specificity decreased slightly.
Risk-based screening achieved the highest overall sensitivity and specificity but widened the eligibility gap between Latinos and Whites and had lower sensitivity for Latinos. These findings suggest that smoking-duration-based criteria could be a fairer alternative to pack-year thresholds, while risk-based approaches may need refinement to ensure equitable access to early lung cancer detection.
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