Evaluating Lung Cancer Screening Patterns and Outcomes in Diverse Populations and Settings

ABSTRACT Lung cancer is the leading cause of cancer deaths in the United States, with higher rates of lung cancer among Black versus White men, despite Black populations having lower smoking rates, smoking fewer cigarettes per day, and being less likely to smoke heavily. Randomized trials demonstrated early detection of lung cancer with annual low dose computed tomography reduces lung cancer mortality by 20-33% in high-risk populations. In 2013 the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) in individuals ages 55-80 years who currently or former (quit within 15 years) smoked at least 30 pack-years. Some studies suggested the 2013 USPSTF LCS eligibility criteria under selected women and Black individuals who tend to smoke less intensely yet have increased risk of developing lung cancer. In 2021, the USPSTF expanded their LCS recommendations to include individuals ages 50-80 years with at least a 20 pack-year history, increasing the number eligible by more than 80% to 14.5 million U.S. adults. These expanded criteria will result in higher relative increases in screening eligibility for women versus men and non-Hispanic Black versus non-Hispanic White populations. Yet, the impact of the expanded 2021 USPSTF eligibility criteria on screening practice and outcomes is unknown. The objective of this application is to understand how the updated 2021 USPSTF LCS recommendations are implemented in practice and quantify the impact of the new recommendations on the LCS care continuum from adherence to performance. Our central hypothesis is that there will be race and sex-based differences in the benefits and harms of LCS among newly eligible individuals (e.g., ages 50-54 years or smoking 20-29 P-Y) because of heterogeneity in the baseline risk of developing lung cancer. Guided by strong preliminary data, the hypothesis will be tested by pursuing the following specific aims: 1) Evaluate patients’ and clinicians' attitudes, knowledge, and experiences with the expanded 2021 USPSTF LCS recommendations; 2) Determine the impact of the 2013 vs. 2021 USPSTF LCS eligibility criteria across the screening care continuum in terms of (a) baseline lung cancer risk in the population screened, (b) adherence to annual LCS, and (c) receipt of recommended care following an abnormal LCS result; and 3) Compare the performance of LDCT LCS in individuals screened per the USPSTF 2013 criteria versus the 2021 newly eligible criteria. The study is innovative in combining survey and quantitative methods in a large, diverse, community-based population to evaluate the impact of the 2021 USPSTF LCS recommendations on LCS care patterns and outcomes. The proposed research is significant because it will quantify the experiences of LCS in the 14.5 million individuals now eligible for screening. The findings are expected to advance and expand our understanding of LCS in diverse populations and settings which will enable clinicians to deliver more evidence based, high-quality LCS care.