Alternative Lung Cancer Screening Criteria Identifies More People Who Would Benefit

Alternative lung cancer screening criteria identifies people who would benefit significantly from screening, but are excluded by current criteria, according to research published in Annals of Internal Medicine.

“We found these high-benefit groups include those who smoked for a long duration, but at a lower intensity, those with heavy smoking who quit more than 15 years ago, and those from some racial and ethnic minority groups,” said Dr. Lauren Kearney, lead author of the study, research fellow at VA Boston’s Center for Healthcare Organization & Implementation Research, pulmonary and critical care fellow at Boston Medical Center, and instructor at Boston University Chobanian & Avedisian School of Medicine.

Researchers used responses to the National Health Interview Survey from more than 58 million smoking adults from 1997 to 2018, to study whether alternative criteria could better identify high-benefit persons and whom this would include. They used fast and frugal tee algorithms to develop an alternative set of simple criteria. The researchers then compared the alternative criteria with U.S. Preventative Services Task Force, or USPSTF, criteria, evaluating their ability to identify high-benefit people. They also looked for where the selected populations overlapped and where the alternative criteria overcame USPSTF criteria limitations.

Results suggest that the alternative criteria have higher sensitivity and specificity in identifying high-benefit people, and is substantially more sensitive in identifying high-benefit people in racial and ethnic minority populations than the USPSTF criteria. Analysis showed inequity in current USPSTF criteria, which has poor sensitivity for identifying high-benefit Black people for lung cancer screening. The researchers also believe that, beyond the lung cancer screening context, their approach could be useful for other cancer screening and prevention modalities.

“The alternative criteria produced more effective screening, led to better support of ethical risk management, and substantially reduced racial disparities in lung cancer screening eligibility,” explained Kearney. “The alternative criteria are also easy to remember and represent a feasible way to improve current lung cancer screening eligibility criteria.”