Randi M Williams1, Samuel A Kareff2, Paul Sackstein3, Tina Roy4, George Luta5, Chul Kim6, Kathryn L Taylor7, Martin C Tammemägi8. 1. Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, NW Suite 300, Washington, DC 20007, United States. Electronic address: rmw27@georgetown.edu. 2. Department of Medicine, University of Miami Sylvester Comprehensive Cancer Center, Jackson Memorial Hospital, 1475 NW 12th Ave, Miami, FL 33136, United States. Electronic address: s.kareff@miami.edu. 3. Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007, United States. Electronic address: Paul.E.Sackstein@medstar.net. 4. Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007, United States. Electronic address: Tina.Roy@medstar.net. 5. Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, 4000 Reservoir Rd NW, Washington, DC 20057, United States. Electronic address: george.luta@georgetown.edu. 6. Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007, United States; Division of Hematology and Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States. Electronic address: Chul.Kim@gunet.georgetown.edu. 7. Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, NW Suite 300, Washington, DC 20007, United States. Electronic address: TAYLORKL@georgetown.edu. 8. Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, Ontario L2S 3A1, Canada. Electronic address: martin.tammemagi@brocku.ca.
Abstract
INTRODUCTION: The United States Preventive Services Task Force (USPSTF) recommendations do not account for race and sex differences in lung cancer risk. We compared the sensitivity for finding lung cancer cases eligible for lung cancer screening (LCS) by USPSTF 2013 recommendations versus the PLCOm2012 model at an equivalent threshold. METHODS: Using Georgetown University Hospital tumor registry, we identified lung cancer cases (≥55 years old) between 2014 and 2018. Medical chart review collected age, sex, race, education, smoking, and clinical characteristics. We compared the percentage meeting eligibility criteria overall, and by race and sex. RESULTS: The cases (N = 447) were 36.6% Black and 52.6% female. The PLCOm2012 and USPSTF 2013 criteria identified 71.4% and 45.6% of cases, respectively (p < 0.0001). This difference was consistent across race and sex sub-groups (p < 0.0001). The PLCOm2012 was more sensitive than the USPSTF in Blacks (69.9% vs. 46.6%, p < 0.0001) and in women (69.8% vs. 41.3%, p < 0.0001). The USPSTF had poor sensitivity for both race groups (Black 46.6%, White 45.9%, p = 0.886) and had lower sensitivity in women vs. men (41.3% vs. 51.4%, p = 0.032). The PLCOm2012 had higher sensitivities in women and men, and difference between sexes was not significant (69.8% vs. 72.6%, p = 0.506). CONCLUSIONS: Compared to the USPSTF 2013 recommendations, the PLCOm2012 model selected a larger proportion of lung cancer cases in all race-sex strata and removed the sex disparity observed for the USPSTF. The PLCOm2012 risk model could be used to identify those who will benefit from LCS.
INTRODUCTION: The United States Preventive Services Task Force (USPSTF) recommendations do not account for race and sex differences in lung cancer risk. We compared the sensitivity for finding lung cancer cases eligible for lung cancer screening (LCS) by USPSTF 2013 recommendations versus the PLCOm2012 model at an equivalent threshold. METHODS: Using Georgetown University Hospital tumor registry, we identified lung cancer cases (≥55 years old) between 2014 and 2018. Medical chart review collected age, sex, race, education, smoking, and clinical characteristics. We compared the percentage meeting eligibility criteria overall, and by race and sex. RESULTS: The cases (N = 447) were 36.6% Black and 52.6% female. The PLCOm2012 and USPSTF 2013 criteria identified 71.4% and 45.6% of cases, respectively (p < 0.0001). This difference was consistent across race and sex sub-groups (p < 0.0001). The PLCOm2012 was more sensitive than the USPSTF in Blacks (69.9% vs. 46.6%, p < 0.0001) and in women (69.8% vs. 41.3%, p < 0.0001). The USPSTF had poor sensitivity for both race groups (Black 46.6%, White 45.9%, p = 0.886) and had lower sensitivity in women vs. men (41.3% vs. 51.4%, p = 0.032). The PLCOm2012 had higher sensitivities in women and men, and difference between sexes was not significant (69.8% vs. 72.6%, p = 0.506). CONCLUSIONS: Compared to the USPSTF 2013 recommendations, the PLCOm2012 model selected a larger proportion of lung cancer cases in all race-sex strata and removed the sex disparity observed for the USPSTF. The PLCOm2012 risk model could be used to identify those who will benefit from LCS.
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