Potential Racial Disparities Using Current Lung Cancer Screening Guidelines

Srinadh Annangi, Snigdha Nutalapati, Marilyn G. Foreman, Rathi Pillai, Eric L. Flenaugh

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. 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. 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. 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. 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.