The Voice

Improving Lung Cancer Screening Eligibility for Black Women

By Priyanka Senthil, Alexandra Potter, Chi-Fu Jeffrey Yang, MD

Every year, approximately 6,300 Black women in the United States die from lung cancer.¹ Lung cancer is one of the leading causes of cancer-related death among Black women. In fact, among Black women, lung cancer is as deadly as breast cancer: each year, a similar number of Black women die from lung cancer as they do from breast cancer.¹ Nearly half of Black women diagnosed with lung cancer are diagnosed at an advanced stage, when the prognosis is poor and 5-year overall survival is less than 10%.¹

Lung cancer screening with low-dose computed tomography (LDCT) is the most promising strategy to detect lung cancer early and reduce lung cancer mortality. Notably, screening with LDCT has been shown to significantly reduce lung cancer mortality by 20-33% in two large-scale randomized trials.^2,3 Currently, annual LDCT screening is recommended by the United States Preventive Services Task Force (USPSTF) for individuals aged 50 to 80 who have at least a 20-pack-year smoking history and who currently smoke or have quit smoking in the last 15 years.⁴ However, most Black women at high risk for lung cancer are currently ineligible for lung cancer screening. A previous study published in JAMA Oncology found that 60% of Black women diagnosed with lung cancer would have been ineligible for lung cancer screening under the current 2021 USPSTF guideline.⁵ The primary reason Black women with lung cancer were ineligible for lung cancer screening was because they had smoked fewer than 20 pack-years. These striking findings demonstrate the woeful inadequacy of the current USPSTF lung cancer screening guideline for Black women and highlight the need for efforts to improve lung cancer screening eligibility for this population.

To address evidence gaps for lung cancer screening and to improve access to early lung cancer detection for Black women, the INSPIRE (Investigating Screening in Populations with Increased Risk to Improve Equity) study, a prospective single-arm study, was launched. The INSPIRE study aims to screen 400 Black women aged 50-80 years old with any history of smoking for lung cancer in Boston and Chicago. Importantly, the study allows any Black women with a smoking history—regardless of the number of pack-years smoked or the number of years since quitting smoking (if they formerly smoked)—to get a lung cancer screening. By opening up opportunities for screening to women with lighter smoking histories and more remote smoking histories, the study aims to better understand the performance of LDCT screening in this population. The findings of the study will generate key data to inform future revisions to the USPSTF lung cancer screening guideline and, ultimately, improve access to early lung cancer detection for high-risk Black women.

The INSPIRE study is ongoing and actively recruiting. For anyone interested in participating in the study, fill out this form.

References:

1. “United States Cancer Statistics: Data Visualizations.” Center for Disease Control.
2. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine 2011;365(5):395-409. DOI: 10.1056/NEJMoa1102873.
3. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. New England Journal of Medicine 2020;382(6):503-513. DOI: 10.1056/NEJMoa1911793.
4. Lung Cancer: Screening, Accessed 6/17/2021.
5. Potter AL, Yang C-FJ, Woolpert KM, Puttaraju T, Suzuki K, Palmer JR. Evaluating Eligibility of US Black Women Under USPSTF Lung Cancer Screening Guidelines. JAMA Oncology 2022;8(1):163-164. DOI: 10.1001/jamaoncol.2021.5790.