Eligibility and Prognostic Performance of Smoking Duration-Based Versus Pack-Year-Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups.
Eligibility and Prognostic Performance of Smoking Duration-Based Versus Pack-Year-Based U.S. National Lung Cancer Screening Criteria Across Racial and Ethnic Groups. Annals of internal medicine 2025Abstract
The U.S. Preventive Services Task Force expanded lung cancer (LC) screening eligibility in 2021 (USPSTF-2021) by decreasing the minimum number of smoking pack-years from 30 to 20. Underrepresented minorities still experience disparities in screening eligibility.To evaluate screening eligibility and prognostic performance of alternative smoking duration-based criteria versus USPSTF-2021 (primary outcome) and risk-based screening using the recalibrated Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012update) model (secondary outcome) across diverse racial and ethnic groups.Prospective, population-based Multiethnic Cohort linked to SEER (Surveillance, Epidemiology, and End Results) registries.California and Hawai'i, with recruitment from 1993 to 1996.105?261 adults aged 45 to 75 years with a history of smoking.Hypothetical eligibility and prognostic performance (sensitivity and specificity) in detecting 6-year LC.Under USPSTF-2021, 24.0% of the cohort would be eligible for screening; a 30-year smoking duration yielded the closest eligibility rate (27.5%). Compared with USPSTF-2021, the 30-year duration criteria would reduce eligibility gaps across all races relative to Whites, most notably in African Americans (30.4% vs. 28.8% for Whites under duration-based; 21.4% vs. 30.2% for Whites under USPSTF-2021) and Latinos (25.1% vs. 28.8% for Whites under duration-based; 15.7% vs. 30.2% for Whites under USPSTF-2021). Prognostic sensitivity to identify LC within 6 years increased across all races under the 30-year duration criteria, although specificity decreased commensurately. At matched overall eligibility (27.5%), a risk-based PLCOm2012update 6-year threshold of 1.1% improved both sensitivity and specificity in the overall cohort. However, it widened the eligibility gap between Latinos and Whites (14.4% vs. 31.3%) and demonstrated lower sensitivity in Latinos than duration-based criteria (59.7% vs. 69.8%).Cohort geography and enrollment period may limit generalizability. Overdiagnosis was not measured.Compared with USPSTF-2021, the 30-year duration-based criteria could reduce the eligibility gaps among African Americans and Latinos relative to Whites while improving 6-year LC detection sensitivity across all races.National Institutes of Health.
View details for DOI 10.7326/ANNALS-25-00464
View details for PubMedID 41397256