Using Prediction Models to Reduce Persistent Racial and Ethnic Disparities in the Draft 2020 USPSTF Lung Cancer Screening Guidelines

Abstract

We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung cancer screening recommendations "partially ameliorate racial disparities in screening eligibility" compared with the 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%-33.4% = 15.0% to 64.5%-48.5% = 16.0%; Asian Americans: 48.3%-35.6% = 12.7% to 64.5%-45.2% = 19.3%; Hispanic Americans: 48.3%-24.8% = 23.5% to 64.5%-37.0% = 27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%-75.5% = 1.2%) and improved screening efficiency for Asian and Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). The draft USPSTF-2020 guidelines increased the number of eligible minorities vs USPSTF-2013 but may inadvertently increase racial and ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit regardless of race and ethnicity.

Figure 1.

The sensitivity of lung cancer screening among those eligible under United States Preventive Services Task Force (USPSTF)-2013 guidelines, USPSTF-2020 draft guidelines, and USPSTF-2020 draft guidelines augmented with those eligible by the life-years from screening with computed tomography (LYFS-CT) individualized model for life-years gained from screening, by race and ethnicity. A) Sensitivity of screening to gainable life-years gained, and absolute disparities, for Whites and African Americans. B) Sensitivity of screening to gainable life-years gained, and absolute disparities, for Whites and Hispanic Americans. C) Sensitivity of screening to gainable life-years gained, and absolute disparities, for Whites and Asian Americans. D) Sensitivity of screening to preventable lung cancer deaths prevented, and absolute disparities, for Whites and African Americans. E) Sensitivity of screening to preventable lung cancer deaths prevented, and absolute disparities, for Whites and Hispanic Americans. F) Sensitivity of screening to preventable lung cancer deaths prevented, and absolute disparities, for Whites and Asian Americans. Disparity estimates are rounded to the nearest percent.