By NCI Staff

Clinical recommendations on who should be screened for lung cancer are based largely on how long a person smoked and the number of cigarettes they smoked. But current recommendations may need to be reviewed when it comes to African Americans who smoke, a new study suggests.

In the study, only about one-third of African American smokers diagnosed with lung cancer over a 12-year period would have met the criteria for annual lung cancer screening with low-dose computed tomography (CT) laid out by the US Preventive Services Task Force (USPSTF). In contrast, more than half of white smokers diagnosed with lung cancer met the criteria.

The findings were reported June 27 in JAMA Oncology. 

Overall, “there’s evidence that African Americans have a higher baseline risk for [developing] lung cancer compared to whites,” said Melinda Aldrich, Ph.D., M.P.H., of Vanderbilt University Medical Center, who led the new study.

But these race-related differences in risk and smoking behaviors aren’t accounted for in current lung cancer screening recommendations, Dr. Aldrich said. According to those recommendations, screening is appropriate for those aged 55 to 80 years with a 30 pack-year smoking history who are still smoking or who quit within the last 15 years.

The researchers estimated that reducing the number of pack-years in the USPSTF recommendations to 20 for African American smokers could bring the proportion recommended for annual screening closer to that of white smokers. If the age criterion was also lowered to 50, that would bring the proportions even closer together.

The study wasn’t designed to measure whether increasing the number of African American smokers recommended for screening would reduce the number of deaths from lung cancer. It also couldn’t measure how changing the criteria might shift the balance of the benefits and harms of screening in African Americans, cautioned Jennifer Croswell, M.D., M.P.H., of NCI’s Healthcare Delivery Research Program, who was not involved with the study.

But, she added, “this study raises an important question about lung cancer screening that’s worth further investigation: Is it being applied in the United States in a manner that best ensures optimal and equitable use?”