The 2021 US Preventive Services Task Force lung cancer screening eligibility criteria disproportionately exclude younger Black patients with lung cancer

Background: The 2021 US Preventive Services Task Force (USPSTF) lung cancer screening guideline may continue to exclude many younger Black individuals who have not yet accumulated enough smoking pack-years to be eligible for screening. The objective of this study was to evaluate the proportions of Black and White patients with lung cancer, stratified by age at diagnosis, who would have been eligible for lung cancer screening.

Methods: Incident lung cancer cases among Black and White individuals aged 50-80 years with a smoking history in the Southern Community Cohort Study (SCCS) were identified for analysis. The proportions of Black and White individuals, stratified by age at diagnosis, who would have qualified for screening under the 2013 and 2021 USPSTF guidelines were calculated.

Results: A total of 1856 individuals met inclusion criteria. Compared to the 2013 USPSTF guideline, the 2021 USPSTF guideline significantly increased the proportions of Black and White patients with lung cancer who would have qualified for screening in all age groups evaluated. However, under the 2021 USPSTF guideline, there remained a notable racial disparity in lung cancer screening eligibility, particularly among younger patients with lung cancer. Only 47.4% and 61.9% of Black patients aged 50-54 and 50-59 years, respectively, would have qualified for screening under the 2021 USPSTF guideline compared to 80.3% and 88.8% of White patients aged 50-54 and 50-59 years, respectively. With increasing age, the racial disparity in lung cancer screening eligibility between Black and White patients with lung cancer was reduced, and there were no longer any statistically significant differences in screening eligibility between Black and White patients with lung cancer aged 70-74 and 75-80 years. Of Black individuals aged 50-54 and 55-59 years who were ineligible for screening, 100% and 97.5% were ineligible because they had smoked fewer than 20 pack-years, respectively.

Conclusions: This analysis of SCCS participants with lung cancer found that the 2021 USPSTF eligibility criteria disproportionately exclude many younger Black individuals with lung cancer, primarily because they have too few smoking pack-years.