Lung cancer screening disparities persist for Black Americans, with USPSTF guidelines and risk models failing to adequately address racial differences in risk and diagnosis.

Lung cancer is the top cause of cancer-related deaths in the U.S., and disparities in lung cancer screening (LCS) and treatment are evident among Black Americans, who tend to develop lung cancer at an earlier age and with a lower smoking history. The 2013 U.S. Preventive Services Task Force (USPSTF) guidelines have been criticized for under-screening high-risk Black populations, and these individuals often face longer treatment delays and reduced access to early-stage surgical interventions. Lung cancer risk prediction models like PLCOm2012 aim to improve sensitivity in detection, particularly in Black populations, but current models may not accurately represent the diverse U.S. population.

A study at Thomas Jefferson University in Philadelphia examined racial differences in 6-year lung cancer risk among Black and white patients in a centralized LCS program. The study found significant differences in the distribution of lung cancer risk scores and actual diagnoses between Black and white patients, with Black patients showing higher median risk scores and a greater distribution in higher risk quartiles. Despite the higher risk scores, Black patients were more likely to be in lower risk quartiles at the time of cancer diagnosis, indicating a misalignment between risk scores and actual diagnoses.

Current clinical trials and risk models for lung cancer may not adequately reflect minority populations, emphasizing the need for research that includes sociocontextual, cultural, and environmental factors affecting these groups. Philadelphia’s high smoking rate, poverty, and income gap exacerbate lung cancer risk factors. Recent USPSTF guidelines have expanded LCS eligibility, but more efforts are needed to address screening disparities and ensure equitable lung cancer outcomes. Collaboration among clinicians, public health professionals, and communities is crucial to overcome barriers and integrate LCS into annual care for high-risk individuals.

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