Department of Biomedical Informatics, University of Utah, Salt Lake City.
Department of Population Health Sciences, University of Utah, Salt Lake City.
JAMA Netw Open. 2021 Jan 4;4(1):e2033769. doi: 10.1001/jamanetworkopen.2020.33769.
Lung cancer incidence and mortality disproportionately affect women and racial/ethnic minority populations, yet screening guidelines for the past several years were derived from clinical trials of predominantly White men. To reflect current evidence, the US Preventive Services Task Force (USPSTF) has revised the eligibility criteria, which may help to ameliorate sex- and race/ethnicity-related disparities in lung cancer screening.
To determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included respondents to the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System who were 50 to 80 years of age with a smoking history in 19 states that used the optional lung cancer screening module. The change in eligibility among female, male, Black, Hispanic, and White participants was examined. Eligibility by sex and race/ethnicity was compared with a reference population. Data were collected from January 1, 2017, to December 31, 2018, and analyzed from May 8 to June 11, 2020.
Self-reported sex, race/ethnicity, age, and smoking history.
Lung cancer screening eligibility using the revised USPSTF criteria. The previous criteria included current or past smokers (within 15 years) who were 55 to 80 years of age and had a smoking history of more than 30 pack-years. In the revised criteria, age was modified to 50 to 80 years; smoking history, to 20 pack-years.
Among 40 869 respondents aged 50 to 80 years with a smoking history, 21 265 (52.0%) were women, 3430 (8.4%) were Black, and 1226 (30.0%) were Hispanic (mean [SD] age, 65.6 [7.9] years). The revised criteria increased eligibility for the following populations: men (29.4% to 38.3% [8.9% difference]; P < .001), women (25.9% to 36.4% [10.5% difference]; P < .001), White individuals (31.1% to 40.9% [9.8% difference]; P < .001), Black individuals (16.3% to 28.8% [12.5% difference]; P < .001), and Hispanic individuals (10.5% to 18.7% [8.2% difference]; P < .001). The odds of eligibility were lower for women compared with men (adjusted odds ratio [AOR], 0.88; 95% CI, 0.79-0.99; P = .04) and for Black (AOR, 0.43; 95% CI, 0.33-0.56; P < .001) and Hispanic populations (AOR, 0.70; 95% CI, 0.62-0.80; P < .001) compared with the White population.
The revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
肺癌的发病率和死亡率不成比例地影响着女性和少数族裔群体，但过去几年的筛查指南是基于主要由白人男性参与的临床试验得出的。为了反映当前的证据，美国预防服务工作组（USPSTF）已经修订了资格标准，这可能有助于改善肺癌筛查中的性别和种族差异。
使用一项大型全国性调查，确定修订后的 USPSTF 肺癌筛查资格标准对女性、黑人和西班牙裔人群的相关变化。
设计、地点和参与者：这项横断面研究包括来自 19 个州的、年龄在 50 岁至 80 岁之间、有吸烟史的、使用可选肺癌筛查模块的疾病控制和预防中心的行为风险因素监测系统的受访者。检查了女性、男性、黑人和西班牙裔参与者中资格标准的变化。按性别和种族比较了合格性，并与参考人群进行了比较。数据于 2017 年 1 月 1 日至 2018 年 12 月 31 日收集，并于 2020 年 5 月 8 日至 6 月 11 日进行了分析。
自我报告的性别、种族、年龄和吸烟史。
使用修订后的 USPSTF 标准进行肺癌筛查资格评估。以前的标准包括目前或过去的吸烟者（在 15 年内），年龄在 55 岁至 80 岁之间，吸烟史超过 30 包年。在修订后的标准中，年龄改为 50 岁至 80 岁；吸烟史改为 20 包年。
在 40869 名年龄在 50 岁至 80 岁之间、有吸烟史的受访者中，21265 名（52.0%）为女性，3430 名（8.4%）为黑人，1226 名（30.0%）为西班牙裔（平均[标准差]年龄为 65.6[7.9]岁）。修订后的标准增加了以下人群的资格：男性（29.4%至 38.3%[8.9%差异]；P<0.001）、女性（25.9%至 36.4%[10.5%差异]；P<0.001）、白人（31.1%至 40.9%[9.8%差异]；P<0.001）、黑人（16.3%至 28.8%[12.5%差异]；P<0.001）和西班牙裔（10.5%至 18.7%[8.2%差异]；P<0.001）。与男性相比，女性的合格几率较低（调整后的优势比[AOR]，0.88；95%CI，0.79-0.99；P=0.04），与黑人（AOR，0.43；95%CI，0.33-0.56；P<0.001）和西班牙裔（AOR，0.70；95%CI，0.62-0.80；P<0.001）人群相比，白人的合格几率较低。
修订后的 USPSTF 指南可能会增加女性、黑人和西班牙裔人群的肺癌筛查率。然而，尽管有这些潜在的改进，没有量身定制的资格标准，肺癌筛查的不平等可能仍然存在。
