The 2013 guidelines were based on the National Lung Screening Trial. Racial disparities partially stemmed from 90% of participants in the trial being white, and its exclusion of fewer white control participants than African American control participants (514 of 838 [61%] versus 436 of 619 [70%]). Even within the control group, the racial disparity was absent when comparing the 2021 USPSTF criteria (401 of 838 [48%] white patients versus 308 of 619 [50%] African American patients) and the PLCOm2012 guidelines (475 of 838 [57%] white patients versus 368 of 619 [60%] African American patients).

White patients with lung cancer had significantly higher mean pack-years and a higher proportion of white patients had 30 or more pack-years of exposure than African Americans. At the same time, a higher proportion of African Americans patients were current smokers.


The researchers say lack of awareness, poor perception and limited access still need to be addressed, as does unfamiliarity among physicians with screening guidelines and challenges of shared decision-making. They recommend incorporating diverse populations into standard practice guideline designs to ensure equitable access among high-risk populations.

“According to the Patient Protection and Affordable Care Act, a grade B recommendation by the USPSTF automatically qualifies one for coverage by Medicare and Medicaid, but as of 2019, only 31 state Medicaid programs confirm coverage of screening for lung cancer,” wrote Dr. Jonathan Nitz and Dr. Cherie Erkmen, in an accompanying commentary. “Lack of clarity in screening recommendations and payment likely impedes the uptake of lung cancer screening, especially among marginalized populations."

Back to HCB News

CT Homepage