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Do Lung Cancer Eligibility Criteria Align with Risk among Blacks and Hispanics?

Fiscella K, Winters P, Farah S, Sanders M, Mohile SG - PLoS ONE (2015)

Bottom Line: At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes.Black men and Hispanic women were affected the most.There was little change in eligibility among Whites.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.

ABSTRACT

Background: Black patients have higher lung cancer risk despite lower pack years of smoking. We assessed lung cancer risk by race, ethnicity, and sex among a nationally representative population eligible for lung cancer screening based on Medicare criteria.

Methods: We used data from the National Health and Nutrition Examination Survey, 2007-2012 to assess lung cancer risk by sex, race and ethnicity among persons satisfying Medicare age and pack-year smoking eligibility criteria for lung cancer screening. We assessed Medicare eligibility based on age (55-77 years) and pack-years (≥ 30). We assessed 6-year lung cancer risk using a risk prediction model from Prostate, Lung, Colorectal and Ovarian Cancer Screening trial that was modified in 2012 (PLCOm2012). We compared the proportions of eligible persons by sex, race and ethnicity using Medicare criteria with a risk cut-point that was adjusted to achieve comparable total number of persons eligible for screening.

Results: Among the 29.7 million persons aged 55-77 years who ever smoked, we found that 7.3 million (24.5%) were eligible for lung cancer screening under Medicare criteria. Among those eligible, Blacks had statistically significant higher (4.4%) and Hispanics lower lung cancer risk (1.2%) than non-Hispanic Whites (3.2%). At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes. Blacks eligible rose by 48% and Hispanics eligible declined by 63%. Black men and Hispanic women were affected the most. There was little change in eligibility among Whites.

Conclusion: Medicare eligibility criteria for lung cancer screening do not align with estimated risk for lung cancer among Blacks and Hispanics. Data are urgently needed to determine whether use of risk-based eligibility screening improves lung cancer outcomes among minority patients.

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Related in: MedlinePlus

Comparison of Medicare lung cancer screening eligibility* with varying cut-points for PLCOm2012 by race/ethnicity.*Eligibility based on age (55–77), pack—year (30) and any smoking within 15 years.
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pone.0143789.g001: Comparison of Medicare lung cancer screening eligibility* with varying cut-points for PLCOm2012 by race/ethnicity.*Eligibility based on age (55–77), pack—year (30) and any smoking within 15 years.

Mentions: We examined the effect of different cut points for the PLCOm2012. We varied cut-points from the 1.3455% used by Tammemagi et al [13] to twice this rate. The results are shown in the Fig 1. The horizontal lines show proportions of the population eligible by race and ethnicity using Medicare criteria. The sloping lines show these proportions based on changes in cut points. It is notable that the lines for non-Hispanic Whites happen to cross at the cut-point we used, 2.12%. In contrast, neither the lines for Blacks or for Hispanics cross. Use of a lower cut-point recently shown to optimize screening efficiency, i.e. 1.51%, [17] yielded similar findings though absolute numbers of Blacks, Whites, and Hispanics who are eligible for screening is higher when this lower threshold for eligibility is applied.


Do Lung Cancer Eligibility Criteria Align with Risk among Blacks and Hispanics?

Fiscella K, Winters P, Farah S, Sanders M, Mohile SG - PLoS ONE (2015)

Comparison of Medicare lung cancer screening eligibility* with varying cut-points for PLCOm2012 by race/ethnicity.*Eligibility based on age (55–77), pack—year (30) and any smoking within 15 years.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664289&req=5

pone.0143789.g001: Comparison of Medicare lung cancer screening eligibility* with varying cut-points for PLCOm2012 by race/ethnicity.*Eligibility based on age (55–77), pack—year (30) and any smoking within 15 years.
Mentions: We examined the effect of different cut points for the PLCOm2012. We varied cut-points from the 1.3455% used by Tammemagi et al [13] to twice this rate. The results are shown in the Fig 1. The horizontal lines show proportions of the population eligible by race and ethnicity using Medicare criteria. The sloping lines show these proportions based on changes in cut points. It is notable that the lines for non-Hispanic Whites happen to cross at the cut-point we used, 2.12%. In contrast, neither the lines for Blacks or for Hispanics cross. Use of a lower cut-point recently shown to optimize screening efficiency, i.e. 1.51%, [17] yielded similar findings though absolute numbers of Blacks, Whites, and Hispanics who are eligible for screening is higher when this lower threshold for eligibility is applied.

Bottom Line: At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes.Black men and Hispanic women were affected the most.There was little change in eligibility among Whites.

View Article: PubMed Central - PubMed

Affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.

ABSTRACT

Background: Black patients have higher lung cancer risk despite lower pack years of smoking. We assessed lung cancer risk by race, ethnicity, and sex among a nationally representative population eligible for lung cancer screening based on Medicare criteria.

Methods: We used data from the National Health and Nutrition Examination Survey, 2007-2012 to assess lung cancer risk by sex, race and ethnicity among persons satisfying Medicare age and pack-year smoking eligibility criteria for lung cancer screening. We assessed Medicare eligibility based on age (55-77 years) and pack-years (≥ 30). We assessed 6-year lung cancer risk using a risk prediction model from Prostate, Lung, Colorectal and Ovarian Cancer Screening trial that was modified in 2012 (PLCOm2012). We compared the proportions of eligible persons by sex, race and ethnicity using Medicare criteria with a risk cut-point that was adjusted to achieve comparable total number of persons eligible for screening.

Results: Among the 29.7 million persons aged 55-77 years who ever smoked, we found that 7.3 million (24.5%) were eligible for lung cancer screening under Medicare criteria. Among those eligible, Blacks had statistically significant higher (4.4%) and Hispanics lower lung cancer risk (1.2%) than non-Hispanic Whites (3.2%). At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes. Blacks eligible rose by 48% and Hispanics eligible declined by 63%. Black men and Hispanic women were affected the most. There was little change in eligibility among Whites.

Conclusion: Medicare eligibility criteria for lung cancer screening do not align with estimated risk for lung cancer among Blacks and Hispanics. Data are urgently needed to determine whether use of risk-based eligibility screening improves lung cancer outcomes among minority patients.

Show MeSH
Related in: MedlinePlus