Closing gaps in cancer screening for high-risk minorities

Identifying gaps in USPSTF lung cancer screening eligibility to reduce health disparities: A retrospective analysis of UIC’s lung cancer cases (2010-2017)

Mary M. Pasquinelli

DNP focus area: Family Nurse Practitioner


Lung cancer is the leading cause of cancer death in the United States. The National Lung Screening Trial showed a 20% reduction in lung cancer mortality by screening high risk patients for lung cancer using low-dose computerized tomography (LDCT). Consequently, the United States Preventive Services Task Force (USPSTF) now recommends lung cancer screening individuals between the ages of 55-80 that are current or former smokers, have a cumulative smoking history of 30 pack-years, and have smoked within the past 15 years. Individuals that fit these criteria are covered by medical insurance without cost sharing under the Affordable Care Act. Guidelines from organizations such as the National Comprehensive Cancer Network (NCCN) expand screening criteria to include individuals age 50 years or older with a 20 pack-year smoking history and at least one additional high risk factor such as a diagnosis of chronic obstructive pulmonary disease or a family history of lung cancer. Finally, a 6-year lung cancer risk assessment model uses a risk calculator (PLCOm2012 risk assessment model) and considers a 6-year risk >1.3% as similar to the USPSTF high-risk group. Improving stratification for lung cancer screening to high-risk subgroups that fall outside of current USPSTF guidelines may improve early detection of lung cancer in certain subgroups and also decrease health disparities.

To determine high-risk subgroups that would not have met USPSTF eligibility criteria for lung cancer screening we retrospectively applied various lung cancer screening criteria to the University of Illinois (UI) Health lung cancer registry (2010-2017) of 823 diagnosed lung cancer cases. Seven-hundred and three cases met study eligibility of being a current or former smoker and a documented smoking history in the electronic medical record. In this cohort, 55% would have met USPSTF or NCCN high-risk (group 1) lung screening criteria, an additional 11% would have met the NCCN high risk (group 2) criteria, and another 15% would have met the NCCN moderate risk criteria with the addition of a risk > 1.3% by applying the PLCOm2012 lung cancer risk calculator.

In summary, this analysis shows that expanding USPSTF lung cancer screening to include NCCN group 2 and/or by use of the PLCOm2012 lung cancer 6-year risk prediction of >1.3% improved the sensitivity of lung cancer screening from 55% to 81%. Since cost can be a barrier to screening for the population that UI Health serves expanding USPSTF criteria for lung cancer screening could help reduce health disparities and save even more lives.