Investigators Call for Increased Eligibility for Black Women in USPSTF

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Revisions made to the lung cancer screening guidelines could increase the proportion of Black women eligible for screening.

A recent research letter published by Julia R. Palmer, ScD, Slone Epidemiology Center at Boston University, and colleagues suggested that removing the years since quitting (YSQ) criteria in the 2021 US Preventive Services Task Force (USPSTF) lung cancer screening guidelines could be beneficial for Black women.

They added that further research should be prioritized to determine if there is a need for sex and race/ethnicity differentiations in future revisions to the guidelines.

Earlier revisions, such as an increase in the number of smokers eligible for screening through lowering the age eligibility from 55 to 50 years and reducing the requisite pack-years of smoking from 30 to 20, was hypothesized to increase the proportion of Black individuals eligible for screening.

However, Palmer and colleagues were concerned with the possibility that many high-risk Black women would still not be considered eligible.

In their quality improvement study, they evaluated lung cancer screening eligibility among US Black women under the 2013 and 2021 USPTF guidelines.

The Methods

Investigators enrolled participants from the Black Women’s Health Study (BWHS), which included women from across the US.

Enrollment began in 1995, and participants were tasked with completing a health questionnaire with detailed information on cigarette smoking and a myriad of other exposures. Information was updated via biennial questionnaires.

A total of 58,973 Black women were included in the study.

Incident lung cancers were identified by self-report, and annual linkages with state cancer registries and the National Death Index.

From there, investigators evaluated the proportion of women diagnosed with lung cancer who would have been eligible under both the 2013 and 2021 USPSTF lung cancer screening guidelines.

Additionally, the sensitivity and specificity of the USPSTF guidelines and alternative guidelines were evaluated based on different criteria for pack-year smoking history and YSQ.

Analyses were conducted using SAS, version 9.4 (SAS Institute).

The Findings

From July 1995 through December 2017, 559 women were diagnosed with lung cancer, with the mean age of diagnosis being 64 years.

Of those cases, 43% were current smokers, 42% were former smokers, and 15% had never smoked.

Under 2013 USPSTF guidelines, 22.7% of BWHS participants with lung cancer who had a smoking history would have been eligible for lung cancer screening.

However, under the new 2021 guidelines the proportion of women eligible for screening increased to 33.9%, representing a 50% increase in eligibility (McNemar test, P < .001).

Investigators found that among the 314 smokers who would not have been eligible for screening under the 2021 guidelines, 67.8% were ineligible for having fewer than 20 pack-years smoking history, while 46.2% were ineligible because they quit smoking more than 15 years ago.

Among the 21,604 BWHS participants who were ever smokers, sensitivity and specificity of the 2021 guidelines were 33.9% and 86.5%, respectively.

The removal of t the requirement that former smokers must have quit smoking within the past 15 years was associated with an increase in sensitivity, to 48.2%, and a decrease in specificity, to 78.9%.

Overall, the team found that the revisions made to the new USPSTF guidelines through the removal of 15 YSQ requirement would increase the proportion of Black women eligible for screening from 33.9% to 48.2%, with a small reduction in specificity.

A limitation of the study, however, was the lack of data on the use of lung cancer screening by eligible individuals.

“Such information may be available in future studies,” the team wrote.

The study, “Evaluating Eligibility of US Black Women Under USPSTF Lung Cancer Screening Guidelines,” was published online in JAMA Open Network.