Basu Anupam, Kopulos Luke, Geissen Nicole, Sukhal Shashvat, Smith Sean B
Program Director, Diagnostic Radiology Residency Program, Department of Radiology, Cook County Health, Chicago, Illinois.
Department of Radiology, Cook County Health, Chicago, Illinois.
J Am Coll Radiol. 2021 Jan;18(1 Pt A):27-33. doi: 10.1016/j.jacr.2020.08.017. Epub 2020 Sep 16.
African Americans were underrepresented in lung cancer screening (LCS) trials, despite having higher lung cancer incidence and worse outcomes compared with Caucasians. There is concern that the 30-pack-year threshold excludes some African Americans who may benefit from LCS.
LCS in an underserved health care system was reviewed. Providers attested that patients met LCS criteria, including 30-pack-year history, but patients also self-reported smoking histories. Self-reported data were used to identify patients with <30-pack-year histories.
Over 2 years, 784 patients self-reported sufficient data to calculate pack-years. The majority were men (57.5%), and 66.2% were African Americans. Median total years smoked was 40 (interquartile range, 30-45 years), and median pack-years was 25 (interquartile range, 15-40 pack-years). African Americans were more likely to report <30 pack-years compared with other races (P < .001). The overall incidence of lung cancer was 2.0%, and incidence was similar for those with ≥30 or <30 pack-years (2.1% versus 2.0%; odds ratio, 0.94; 95% confidence interval, 0.35-2.53; P = .902). Race was not associated with lung cancer diagnosis, but African Americans were the only race to have lung cancer if pack-years were <30. The incidence of cancer in African Americans was similar in those who reported ≥30 or <30 pack-years (2.2% versus 2.7%; odds ratio, 1.21; 95% confidence interval, 0.39-3.75; P = .740), and the 30-pack-year threshold was not associated with lung cancer diagnosis.
This is the first review of LCS in African Americans who self-reported <30 pack-years. Although retrospective, these data raise concern that the 30-pack-year threshold may not be an appropriate LCS criterion in African Americans.
尽管非裔美国人肺癌发病率高于白种人且预后较差，但他们在肺癌筛查（LCS）试验中的代表性不足。有人担心30包年的阈值排除了一些可能从LCS中受益的非裔美国人。
对一个服务不足的医疗保健系统中的LCS进行了回顾。提供者证明患者符合LCS标准，包括30包年的吸烟史，但患者也自行报告了吸烟史。自行报告的数据用于识别吸烟史少于30包年的患者。
在两年多的时间里，784名患者自行报告了足够的数据来计算包年数。大多数是男性（57.5%），66.2%是非裔美国人。吸烟总年数的中位数为40年（四分位间距，30 - 45年），包年数的中位数为25包年（四分位间距，15 - 40包年）。与其他种族相比，非裔美国人更有可能报告少于30包年的吸烟史（P <.001）。肺癌的总体发病率为2.0%，吸烟史≥30包年或<30包年的患者发病率相似（2.1%对2.0%；比值比，0.94；95%置信区间，0.35 - 2.53；P =.902）。种族与肺癌诊断无关，但如果包年数<30，非裔美国人是唯一患肺癌的种族。报告吸烟史≥30包年或<30包年的非裔美国人的癌症发病率相似（2.2%对2.7%；比值比，1.21；95%置信区间，0.39 - 3.75；P =.740），30包年的阈值与肺癌诊断无关。
这是首次对自行报告吸烟史少于30包年的非裔美国人进行的LCS回顾。尽管是回顾性研究，但这些数据引发了人们对30包年阈值可能不是非裔美国人合适的LCS标准的担忧。
