Sensitivity of US Preventive Services Task Force and PLCOm2012 lung cancer screening eligibility criteria in individuals with lung cancer in South Dakota self‐reporting as Indigenous and non‐Indigenous

• Published in: Cancer Vol. 129; no. 24; pp. 3894 - 3904
• Main Authors: Tammemägi, Martin Carl, Cina, Kristin, Kitts, Andrea K. Borondy, Koop, David, Petereit, Mark A., Sargent, Michele, Petereit, Daniel G.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.12.2023
• Subjects: American Indian; Cancer screening; Colorectal Neoplasms - complications; Computed tomography; Criteria; Early Detection of Cancer - methods; Fatalities; Health risks; Humans; Indigenous; Lung cancer; lung cancer screening; Lung Neoplasms; Male; Mass Screening - methods; Medical screening; Ovarian cancer; Ovaries; Prediction models; Prostate; Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial 2012 lung cancer risk‐prediction model (PLCOm2012); Risk; Risk Assessment; Smoke; South Dakota - epidemiology; Task forces; Tomography; US Preventive Services Task Force (USPSTF); South Dakota; United States > US; Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial 2012 lung cancer risk-prediction model (PLCOm2012); lung cancer screening; American Indian; Indigenous; US Preventive Services Task Force (USPSTF)
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34947

Background Lung cancer is the leading cause of cancer deaths. Screening individuals who are at elevated risk using low‐dose computed tomography reduces lung cancer mortality by ≥20%. Individuals who have community‐based factors that contribute to an increased risk of developing lung cancer have high lung cancer rates and are diagnosed at younger ages. In this study of lung cancer in South Dakota, the authors compared the sensitivity of screening eligibility criteria for self‐reported Indigenous race and evaluated the need for screening at younger ages. Methods US Preventive Services Task Force (USPSTF) 2013 and 2021 (USPSTF2013 and USPSTF2021) criteria and two versions of the PLCOm2012 risk‐prediction model (based on the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial), one with a predictor for race and one without, were applied at USPSTF‐equivalent thresholds of ≥1.7% in 6 years and ≥1.0% in 6 years to 1565 individuals who were sequentially diagnosed with lung cancer (of whom 12.7% self‐reported as Indigenous) at the Monument Health Cancer Care Institute in South Dakota (2010–2019). Results Eligibility sensitivities of USPSTF criteria did not differ significantly between individuals who self‐reported their race as Indigenous and those who did not (p > .05). Sensitivities of both PLCOm2012 models were significantly higher than comparable USPSTF criteria. The sensitivity of USPSTF2021 criteria was 66.1% and, for comparable PLCOm2012 models with and without race, sensitivity was 90.7% and 89.6%, respectively (both p < .001); 1.4% of individuals were younger than 50 years, and proportions did not differ by Indigenous classification (p = .518). Conclusions Disparities in screening eligibility were not observed for individuals who self‐reported their race as Indigenous. USPSTF criteria had lower sensitivities for lung cancer eligibility. Both PLCOm2012 models had high sensitivities, with higher sensitivity for the model that included race. The PLCOm2012noRace model selected effectively in this population, and screening individuals younger than 50 years did not appear to be justified. Plain Language Summary Lung cancer is the leading cause of cancer deaths. Studies show that using low‐dose computed tomography scans to screen people who smoke or who used to smoke and are at elevated risk for lung cancer reduces lung cancer deaths. This study of 1565 individuals with lung cancer in South Dakota compared screening eligibility using US Preventive Services Task Force (USPSTF) criteria and a lung cancer risk‐prediction model (PLCOm2012; from the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). The model had higher sensitivity and picked more people with lung cancer to screen compared with USPSTF criteria. Eligibility sensitivities were similar for individuals who self‐reported as Indigenous versus those who did not between USPSTF criteria and the model. In a study of 1565 individuals with lung cancer in South Dakota, the PLCOm2012 lung cancer risk‐prediction model was more sensitive for lung cancer screening eligibility in individuals with lung cancer than US Preventive Services Task Force criteria (90% vs. 66%). Eligibility sensitivity was similar for individuals who self‐reported as Indigenous versus those who did not using both the US Preventive Services Task Force criteria and the PLCOm2012 model.