Association of Inclusion of More Black Individuals in Lung Cancer Screening With Reduced Mortality.
JAMA Netw Open
; 4(8): e2119629, 2021 08 02.
Article
em En
| MEDLINE
| ID: mdl-34427681
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, andParticipants:
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 andMeasures:
Lung cancer mortality and all-cause mortality.Results:
This study included a total of 53â¯452 participants enrolled in the NLST. Of 2376 Black individuals and 51â¯076 non-Black individuals, 21â¯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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Base de dados:
MEDLINE
Assunto principal:
Negro ou Afro-Americano
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Programas de Rastreamento
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Detecção Precoce de Câncer
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Neoplasias Pulmonares
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article