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Randomized Controlled Trial
. 2021 Aug 2;4(8):e2119629.
doi: 10.1001/jamanetworkopen.2021.19629.

Association of Inclusion of More Black Individuals in Lung Cancer Screening With Reduced Mortality

Ashley E Prosper  1   2 , Kosuke Inoue  3   4 , Kathleen Brown  1 , Alex A T Bui  1   2 , Denise Aberle  1   2   5 , William Hsu  1   2   5
Affiliations
Randomized Controlled Trial

Association of Inclusion of More Black Individuals in Lung Cancer Screening With Reduced Mortality

Ashley E Prosper et al. JAMA Netw Open. .

Abstract

Importance: The potential to achieve greater reductions in lung cancer mortality than originally estimated by the National Lung Screening Trial with the inclusion of more Black participants stresses the importance of improving access to lung cancer screening for Black current and former smokers, a population presently with the highest lung cancer morbidity and mortality.

Objective: To estimate lung cancer and all-cause mortality reductions achievable with lung cancer screening via low-dose computed tomography (LDCT) of the chest in populations with greater proportions of Black screening participants than seen in the original NLST cohort.

Design, setting, and participants: This cohort study was conducted as a secondary analysis of existing data from the National Lung Screening Trial, a large national randomized clinical trial conducted from 2002 through 2009. NLST participants were current or former smokers, aged between 55 and 74 years, with at least 30 pack-years of smoking history and less than 15 years since quitting. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% CIs of lung cancer mortality and all-cause mortality according to LDCT screening compared with chest radiograph screening. Using a transportability formula, we estimated outcomes for LDCT screening among hypothetical populations by varying the distributions of Black individuals, women, and current smokers. Data were analyzed between September 2020 and March 2021.

Exposures: Lung screening with LDCT of the chest compared with chest radiography.

Main outcomes and measures: Lung cancer mortality and all-cause mortality.

Results: This study included a total of 53 452 participants enrolled in the NLST. Of 2376 Black individuals and 51 076 non-Black individuals, 21 922 (41.0%) were women and the mean (SD) age was 61.4 (5.0) years. Over a median (interquartile range) follow-up of 6.7 (6.2-7.0) years, LDCT screening among the synthesized population with a higher proportion of Black individuals (13.4%, mirroring US Census data) was associated with a greater relative reduction of lung cancer mortality (eg, Black individuals: HR, 0.82; 95% CI, 0.72-0.92; vs entire NLST cohort: HR, 0.84; 95% CI, 0.76-0.96). Further reductions in lung cancer mortality by LDCT screening were found among a hypothetical population with a higher proportion of men or current smokers, along with a higher proportion of Black individuals (ie, 60% Black participants; 20% to 40% women) (HR, 0.68; 95% CI, 0.48-0.97).

Conclusions and relevance: The potential to achieve greater reductions in lung cancer mortality than originally estimated by the NLST with the inclusion of more Black participants stresses the critical importance of improving access to lung cancer screening for Black current and former smokers.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Aberle reported serving as national primary investigator for the American College of Radiology Imaging Network and site primary investigator for University of California, Los Angeles during the conduct of the study. No disclosures were reported.

Figures

Figure 1.
Figure 1.. Association Between Lung Screening With LDCT and Mortality Rates When Varying Hypothetical Distributions of the Black Population
HR indicates hazard ratios; LDCT, low-dose computed tomography; NLST, National Lung Screening Trial. The shaded area represents 95% CIs for mortality risk. Estimated mortality reductions are 16% in NLST (orange line) and 18% for the US Census (blue line) in panel A, and 6.7% in NLST and 8% for the census in panel B.
Figure 2.
Figure 2.. Heat Map of Association Between Lung Screening With LDCT and Mortality Rates When Varying Hypothetical Distributions of the Black Population and Sex
HR indicates hazard ratio; LDCT, low-dose computed tomography.
Figure 3.
Figure 3.. Heat Map of Association Between Lung Screening With LDCT and Mortality Rates When Varying Hypothetical Distributions of the Black Population and Smoking Status
HR indicates hazard ratio; LDCT, low-dose computed tomography.
See this image and copyright information in PMC

Comment in

References

    1. Lung cancer statistics. US Centers for Disease Control and Prevention . Updated September 22, 2020. Accessed October 11, 2020. https://www.cdc.gov/cancer/lung/statistics/index.htm
    1. DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin. 2019;69(3):211-233. doi:10.3322/caac.21555 - DOI - PubMed
    1. Aberle DR, Adams AM, Berg CD, et al. ; National Lung Screening Trial Research Team . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873 - DOI - PMC - PubMed
    1. de Koning HJ, Meza R, Plevritis SK, et al. . Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the US Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. doi:10.7326/M13-2316 - DOI - PMC - PubMed
    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. . Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6):503-513. doi:10.1056/NEJMoa1911793 - DOI - PubMed

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