Cancer Causes & Control

, Volume 30, Issue 3, pp 235–240 | Cite as

Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking

  • Chien-Ching LiEmail author
  • Alicia K. Matthews
  • Mantle M. Rywant
  • Emily Hallgren
  • Raj C. Shah
Brief report



Lung cancer early detection screening has been demonstrated to decrease lung cancer mortality among high-risk smokers. This study aimed to examine whether current screening guidelines may disproportionately exclude African American smokers who are at higher overall risk for lung cancer.


Data from the 2014 Health and Retirement Study were analyzed. Older African Americans and Whites with a history of smoking were included in the analyses (n = 7,348). Eligibility criteria established by the U.S. Preventive Services Task Force (USPSTF) for LDCT lung cancer screening were used. Multivariate logistic regression analyses were conducted to examine racial differences in eligibility for LDCT lung cancer screening.


Overall, 21.1% of current and 10.5% of former smokers met USPSTF’s eligibility criteria for LDCT screening. In multivariate logistic regression analyses, African American smokers were less likely to be eligible for LDCT lung cancer screening compared to Whites (odds ratio = 0.5; p < 0.001).


African American smokers were less likely to meet established lung cancer screening eligibility criteria compared to Whites. Current lung cancer screening criteria may not adequately capture African Americans at risk and may widen the health disparities in African Americans. Further longitudinal studies are needed to evaluate the efficacy of current lung cancer screening guideline.


Lung cancer screening Racial disparities Low-dose computed tomography African American Smoking 



The Health and Retirement Study analyzed in the study is sponsored by the National Institute on Aging (NIA U01AG009740) and is conducted by the University of Michigan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    American Cancer Society (2016) Cancer facts & figs. American Cancer Society, AtlantaGoogle Scholar
  2. 2.
    US Department of Health Human Services (2014) The health consequences of smoking—50 years of progress. A report of the Surgeon GeneralGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (2016) Cigarette smoking among adults—United States, 2005–2015. Morb Mortal Wkly Rep 65(44):1205–1211Google Scholar
  4. 4.
    Howlader N, Krapcho M, Miller D et al (2016) SEER cancer statistics review, 1975–2013. National Cancer Institute, BethesdaGoogle Scholar
  5. 5.
    American Lung Association (2015) Too many cases, too many deaths: lung cancer in African Americans. American Lung Association, WashingtonGoogle Scholar
  6. 6.
    Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ (2006) Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Prev Biomark 15:25–31CrossRefGoogle Scholar
  7. 7.
    Morello-Frosch R, Jesdale BM (2006) Separate and unequal: residential segregation and estimated cancer risks associated with ambient air toxics in US metropolitan areas. Environ Health Perspect 114:386CrossRefGoogle Scholar
  8. 8.
    Ford JG, Howerton MW, Lai GY et al (2008) Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer 112:228–242CrossRefGoogle Scholar
  9. 9.
    Association AL (2016) Providing guidance on lung cancer screening to patients and physicians. An update from the American Lung Association Screening Committee. 30 April 2015Google Scholar
  10. 10.
    National Lung Screening Trial Research Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395CrossRefGoogle Scholar
  11. 11.
    Tanner NT, Gebregziabher M, Hughes Halbert C, Payne E, Egede LE, Silvestri GA (2015) Racial differences in outcomes within The National Lung Screening Trial. Implications for widespread implementation. Am J Respir Critical Care Med 192:200–208CrossRefGoogle Scholar
  12. 12.
    Moyer VA (2014) Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Internal Med 160:330–338Google Scholar
  13. 13.
    Medicare Cf, Services M (2015) Decision memo for screening for lung cancer with low dose computed tomography (LDCT)(CAG-00439N)Google Scholar
  14. 14.
    Holford TR, Levy DT, Meza R (2016) Comparison of smoking history patterns among African American and White Cohorts in the United States born 1890 to 1990. Nicotine Tob Res 18:S16–S29CrossRefGoogle Scholar
  15. 15.
    Roberts ME, Colby SM, Lu B, Ferketich AK (2016) Understanding tobacco use onset among African Americans. Nicotine Tob Res 18:S49–S56CrossRefGoogle Scholar
  16. 16.
    Ryan BM (2016) Differential eligibility of African American and European American lung cancer cases using LDCT screening guidelines. BMJ 3:e000166Google Scholar
  17. 17.
    Heeringa SG, Connor JH (1995) Technical description of the Health and Retirement Survey sample design. University of Michigan, Ann ArborCrossRefGoogle Scholar
  18. 18.
    RAND Center for the Study of Aging (2011) RAND HRS Data Documentation, Version K. Santa Monica, CAGoogle Scholar
  19. 19.
    Pinsky PF, Kramer BS (2015) Lung cancer risk and demographic characteristics of current 20–29 pack-year smokers: implications for screening. J Natl Cancer Inst 107:djv226CrossRefGoogle Scholar
  20. 20.
    Nemesure B, Plank A, Reagan L, Albano D, Reiter M, Bilfinger TV (2017) Evaluating efficacy of current lung cancer screening guidelines. J Med Screen 24:208–213CrossRefGoogle Scholar
  21. 21.
    Control CFD, Prevention (2011) Quitting smoking among adults–United States, 2001–2010. MMWR 60:1513Google Scholar
  22. 22.
    Haiman CA, Stram DO, Wilkens LR et al (2006) Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med 354:333–342CrossRefGoogle Scholar
  23. 23.
    Robbins HA, Engels EA, Pfeiffer RM, Shiels MS (2015) Age at cancer diagnosis for blacks compared with whites in the United States. JNCI 107(3):dju489CrossRefGoogle Scholar
  24. 24.
    Schwartz AG, Swanson GM (1997) Lung carcinoma in African Americans and whites: a population-based study in metropolitan Detroit, Michigan. Cancer 79:45–52CrossRefGoogle Scholar
  25. 25.
    Fiscella K, Winters P, Farah S, Sanders M, Mohile SG (2015) Do lung cancer eligibility criteria align with risk among blacks and hispanics? PLoS ONE 10: e0143789CrossRefGoogle Scholar
  26. 26.
    Tammemägi MC (2015) Application of risk prediction models to lung cancer screening: a review. J. Thorac. Imaging 30:88–100CrossRefGoogle Scholar
  27. 27.
    Tammemägi MC, Katki HA, Hocking WG et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 368:728–736CrossRefGoogle Scholar
  28. 28.
    Katki HA, Kovalchik SA, Berg CD, Cheung LC, Chaturvedi AK (2016) Development and validation of risk models to select ever-smokers for CT lung cancer screening. Jama 315:2300–2311CrossRefGoogle Scholar
  29. 29.
    Etzel CJ, Kachroo S, Liu M et al (2008) Development and validation of a lung cancer risk prediction model for African-Americans. Cancer Prev Res 1:255–265CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Health Systems ManagementRush UniversityChicagoUSA
  2. 2.Department of Health Systems ScienceUniversity of Illinois at ChicagoChicagoUSA
  3. 3.Department of SociologyUniversity of Illinois at ChicagoChicagoUSA
  4. 4.Department of Family MedicineRush University Medical CanterChicagoUSA

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