Advertisement

Potential Racial Disparities Using Current Lung Cancer Screening Guidelines

  • Srinadh Annangi
  • Snigdha Nutalapati
  • Marilyn G. Foreman
  • Rathi Pillai
  • Eric L. FlenaughEmail author
Article

Abstract

Rationale

The current age threshold for lung cancer screening targets individuals beginning at age 55. These guidelines were developed based on results from the National Lung Cancer Screening Trial where only 4.4% of the enrollees were African American, when they represent 12.3% of US population. African Americans were also found to have higher incidence and younger onset of lung cancer. We hypothesized that implementation of screening at age 55 would not detect a substantial fraction of early onset lung cancer cases in African American population.

Objectives

We used Surveillance, Epidemiology, and End Results (SEER) Program data to determine the frequency of early-onset lung cancers and to assess the stage at diagnosis in a biracial sample.

Methods

Microscopically confirmed lung cancer (primary site code C 34) cases were identified using SEER 18 registry (2004–2014). Early-onset cancers were defined as cancers diagnosed in persons aged 45 to 54 years. Cases were stratified by race and age groups. Comparisons were evaluated with chi-square tests.

Results

468,403 lung cancers were diagnosed during this period. Nearly 9% of all lung cancers were early onset, with increased frequency in African Americans vs. Whites, 14.2 vs. 8.2%, p < 0.05. Age-adjusted incidence rates were significantly higher in African Americans with highest percent difference noted for age group 50–54. African Americans were more likely to be diagnosed at advanced stages of lung cancer compared to Whites.

Conclusions

We conclude that the current age threshold for lung cancer screening may potentially miss a considerable number of lung cancer cases in African Americans. Further studies are needed to determine the appropriateness of screening age criteria for African Americans.

Keywords

Lung cancer Early detection of cancer African Americans Health care disparities 

Notes

Financial Support

This work was supported by The Georgia Research Alliance Distinguished Scientist (ELF) and RCMI Translational Research Network, U54MD008149 (MGF).

Author Contributions

SA: data acquisition, data management, analysis, study design, manuscript writing and final approval, and accountability; SN: data acquisition, data management, analysis, study design and manuscript writing and final approval, and accountability; MGF: study design, analysis, intellectual content, manuscript writing and final approval, and accountability; RP: study design, manuscript writing and final approval, and accountability; ELF: study design, intellectual content, manuscript writing and final approval, and accountability.

References

  1. 1.
    Moyer VA, Force USPST. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330–8.Google Scholar
  2. 2.
  3. 3.
    Haiman CA, Stram DO, Wilkens LR, Pike MC, Kolonel LN, Henderson BE, et al. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med. 2006;354:333–42.CrossRefGoogle Scholar
  4. 4.
    Harris RE, Zang EA, Anderson JI, Wynder EL. Race and sex differences in lung cancer risk associated with cigarette smoking. Int J Epidemiol. 1993;22:592–9.CrossRefGoogle Scholar
  5. 5.
    Fiscella K, Winters P, Farah S, Sanders M, Mohile SG. Do lung CANCER eligibility criteria align with risk among blacks and Hispanics? PLoS One. 2015;10:e0143789.CrossRefGoogle Scholar
  6. 6.
    Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: incidence—SEER 18 Regs Research Data, Nov 2016 Sub (1973–2014) <Katrina/Rita Population Adjustment>—Linked To County Attributes—Total U.S., 1969–2015 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, released April 2017, based on the November 2016 submission.
  7. 7.
    Howard DH, Richards TB, Bach PB, Kegler MC, Berg CJ. Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening. Cancer. 2015;121:4341–7.CrossRefGoogle Scholar
  8. 8.
    Pang HH, Wang X, Stinchcombe TE, Wong ML, Cheng P, Ganti AK, et al. Enrollment trends and disparity among patients with lung cancer in national clinical trials, 1990 to 2012. J Clin Oncol. 2016;34:3992–9.CrossRefGoogle Scholar
  9. 9.
    National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.CrossRefGoogle Scholar
  10. 10.
    Bureau UC. 2010 Census redistricting data (public law 94–171) summary files tables P1 and P2.Google Scholar
  11. 11.
    Centers for Disease Control Prevention. Cigarette smoking among adults—United States, 2003. MMWR Morb Mortal Wkly Rep. 2005;54:509.Google Scholar
  12. 12.
    Benowitz N, Blum A, Braithwaite R, Castro F. Tobacco use among US racial/ethnic minority groups-African Americans, American indians and Alaska natives, Asian Americans and Pacific islanders, and Hispanics: a report of the surgeon general. 1998.Google Scholar
  13. 13.
    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Srinadh Annangi
    • 1
  • Snigdha Nutalapati
    • 2
  • Marilyn G. Foreman
    • 3
  • Rathi Pillai
    • 4
  • Eric L. Flenaugh
    • 3
    • 5
    Email author
  1. 1.Division of Pulmonary Critical care and Sleep Medicine, College of MedicineUniversity of KentuckyLexingtonUSA
  2. 2.Department of MedicineMorehouse School of MedicineAtlantaUSA
  3. 3.Department of Medicine, Division of Pulmonary and Critical Care MedicineMorehouse School of MedicineAtlantaUSA
  4. 4.Department of Hematology and Oncology, Winship Cancer InstituteEmory University School of MedicineAtlantaUSA
  5. 5.Department of Internal Medicine, Division of Pulmonary and Critical Care MedicineMorehouse School of MedicineAtlantaUSA

Personalised recommendations