Lung cancer testing skewed more toward men than women

A new University of Illinois Cancer Center study found women were more likely to be ineligible for lung cancer screening compared to men under United States Preventative Services Task Force (USPSTF) testing guidelines. The study was published in the journal CHEST.

University of Illinois Cancer Center member Dr. Lawrence Feldman and Mary Pasquinelli, DNP, led research comparing the USPSTF eligibility criteria to the PLCOm2012 risk prediction model to learn if lung cancer screening disparities exist between genders. The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a randomized controlled trial studying screening to reduce cancer mortality.

Lung cancer is the leading cause of cancer deaths in women, killing more women each year than breast, uterine, and ovarian cancer combined. In 2020, about 63,220 lung cancer deaths occurred in women, exceeding the second leading cause – breast cancer – by about 21,050 deaths.

“Women at risk of lung cancer should have equal access to screening as men,” Feldman said. “It is critical that USPSTF and similar guidelines, such as those developed by the Centers for Medicare & Medicaid Services, reflect equity in screening because insurance coverage decisions in the United States are based on these recommendations.”

The USPSTF eligibility criteria, first developed in 2013 and revised in March 2021, recommends low dose computed tomography screening for people 55-80 years old with a history of cigarette smoking for 30 or more years and who quit smoking within the past 15 years.

The updated USPSTF standards reduced the history of cigarette smoking from 30 or more years to 20 or more years and lowered the age of individuals with a smoking history to 50 years. 

The risk prediction model PLCOm2012 does not restrict screening to age, years of smoking and quit year. It instead includes 11 predictors: age, race/ethnicity, diagnosis of chronic obstructive pulmonary disease (COPD) or emphysema, family history of lung cancer, personal history of other cancers, body mass index (BMI), highest education level attained, smoking status (current or former), smoking intensity (average cigarettes per day), duration of smoking in years, and time (years) since quitting.

The study analyzed data from 883 lung cancer cases from UI Health’s Chicago Race Eligibility for Screening Cohort (CREST) from 2010 to 2019. Nearly 47% of women and about 65% men tested positive for screening eligibility using the USPSTF 2013 model, and about 57% for women and about 72% for men in the USPSTF 2021 version.

Feldman and Pasquinelli used risk thresholds of more than 1.7% over six years and more than 1% over six years smoking, respectively, in the PLCOm2012 analysis. The screening positivity rate was about 65% for women and about 71% for men in the 1.7% threshold, and 77% and 82%, respectively, for the 1% threshold.

Lung cancers differ in women and men in several ways, but evidence indicates that women will benefit as least as much, if not more, than men in lung cancer screening, Feldman said.

“Inclusion of the PLCOm2012 risk model to USPSTF eligibility criteria would reduce gender disparities in lung cancer screening and could improve lung cancer outcomes for women and men,” he said.

Co-authors on the study, titled “Addressing Gender Disparities in Lung Cancer Screening Eligibility: USPSTF versus PLCOm2012 Criteria,” include Martin Tammemagi, PhD; Dr. Kevin Kovitz, MBA; Marianne Durham, DNP; Zane Deliu, MS; Arielle Guzman, MPH; Kayleigh Rygalski, BS; Li Liu, PhD; Dr. Matthew Koshy; and Dr. Patricia Finn.

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