Skip to main content

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

Cancer Causes & Control volume 30, pages 235–240 (2019)Cite this article

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. American Cancer Society (2016) Cancer facts & figs. American Cancer Society, Atlanta

    Google Scholar 

  2. US Department of Health Human Services (2014) The health consequences of smoking—50 years of progress. A report of the Surgeon General

  3. Centers for Disease Control and Prevention (2016) Cigarette smoking among adults—United States, 2005–2015. Morb Mortal Wkly Rep 65(44):1205–1211

    Google Scholar 

  4. Howlader N, Krapcho M, Miller D et al (2016) SEER cancer statistics review, 1975–2013. National Cancer Institute, Bethesda

    Google Scholar 

  5. American Lung Association (2015) Too many cases, too many deaths: lung cancer in African Americans. American Lung Association, Washington

    Google Scholar 

  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 15:25–31

    Article  Google Scholar 

  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 114:386

    Article  CAS  PubMed  Google Scholar 

  8. Ford JG, Howerton MW, Lai GY et al (2008) Barriers to recruiting underrepresented populations to cancer clinical trials: a systematic review. Cancer 112:228–242

    Article  PubMed  Google Scholar 

  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 2015

  10. National Lung Screening Trial Research Team (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395

    Article  Google Scholar 

  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 192:200–208

    Article  Google Scholar 

  12. Moyer VA (2014) Screening for lung cancer: US Preventive Services Task Force recommendation statement. Ann Internal Med 160:330–338

    Google Scholar 

  13. Medicare Cf, Services M (2015) Decision memo for screening for lung cancer with low dose computed tomography (LDCT)(CAG-00439N)

  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–S29

    Article  PubMed  PubMed Central  Google Scholar 

  15. Roberts ME, Colby SM, Lu B, Ferketich AK (2016) Understanding tobacco use onset among African Americans. Nicotine Tob Res 18:S49–S56

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ryan BM (2016) Differential eligibility of African American and European American lung cancer cases using LDCT screening guidelines. BMJ 3:e000166

    Google Scholar 

  17. Heeringa SG, Connor JH (1995) Technical description of the Health and Retirement Survey sample design. University of Michigan, Ann Arbor

    Book  Google Scholar 

  18. RAND Center for the Study of Aging (2011) RAND HRS Data Documentation, Version K. Santa Monica, CA

  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:djv226

    Article  PubMed  PubMed Central  Google Scholar 

  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 24:208–213

    Article  PubMed  Google Scholar 

  21. Control CFD, Prevention (2011) Quitting smoking among adults–United States, 2001–2010. MMWR 60:1513

    Google Scholar 

  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 354:333–342

    Article  CAS  PubMed  Google Scholar 

  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):dju489

    Article  PubMed  Google Scholar 

  24. Schwartz AG, Swanson GM (1997) Lung carcinoma in African Americans and whites: a population-based study in metropolitan Detroit, Michigan. Cancer 79:45–52

    Article  CAS  PubMed  Google Scholar 

  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: e0143789

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Tammemägi MC (2015) Application of risk prediction models to lung cancer screening: a review. J. Thorac. Imaging 30:88–100

    Article  PubMed  Google Scholar 

  27. Tammemägi MC, Katki HA, Hocking WG et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 368:728–736

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 315:2300–2311

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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 1:255–265

    Article  Google Scholar 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

  1. Department of Health Systems Management, Rush University, Chicago, IL, USA

    Chien-Ching Li & Mantle M. Rywant

  2. Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA

    Alicia K. Matthews

  3. Department of Sociology, University of Illinois at Chicago, Chicago, IL, USA

    Emily Hallgren

  4. Department of Family Medicine, Rush University Medical Canter, Chicago, IL, USA

    Raj C. Shah

Authors
  1. Chien-Ching Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alicia K. Matthews
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mantle M. Rywant
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily Hallgren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raj C. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chien-Ching Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Li, CC., Matthews, A.K., Rywant, M.M. et al. Racial disparities in eligibility for low-dose computed tomography lung cancer screening among older adults with a history of smoking. Cancer Causes Control 30, 235–240 (2019). https://doi.org/10.1007/s10552-018-1092-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-018-1092-2

Keywords

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