{"entity":{"id":"paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","kind":"paper","name":"Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers","aka":[],"tldr":"The screening rules were written from a trial in which only 4 percent of participants were Black. In a southern United States cohort, 31 percent of white smokers qualified for screening but only 17 percent of Black smokers, even though Black smokers develop lung cancer at fewer cigarettes.","summary":"Aldrich, Mercaldo, Sandler, Blot, Grogan and Blume tested the diagnostic accuracy of the 2013 United States Preventive Services Task Force eligibility criteria in the Southern Community Cohort Study, a predominantly African American and low-income cohort recruited through community health centres across twelve southern states from 2002 to 2009 and followed for cancer incidence to the end of 2014.\n\nThe finding is a mechanical consequence of writing eligibility in pack-years: Black smokers in the United States smoke fewer cigarettes per day on average but carry a higher lung cancer risk at any given exposure, so a pack-year threshold calibrated on a mostly white trial population excludes them disproportionately. The 2021 update lowered the threshold partly in response.","asOf":"2026-09-25","links":[{"label":"JAMA Oncol 2019","url":"https://doi.org/10.1001/jamaoncol.2019.1402"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/31246249/"}],"tags":["lung-evidence"],"related":["paper-uspstf-lung-cancer-screening-jama-2021","paper-nlst-nejm-2011","idea-prev-lung-screening-risk-model-eligibility","idea-prev-mobile-lung-screening-deprived-areas"],"cancers":["lung-cancer","nsclc"],"sections":["early-detection"],"technologies":["low-dose-ct-screening"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-trial-diversity","b-global-access","b-care-fragmentation"],"keyPapers":[],"journals":["jama-oncology"],"dependsOn":[],"notes":[],"journal":"JAMA Oncology","year":2019,"doi":"10.1001/jamaoncol.2019.1402","pmid":"31246249","authors":"Aldrich MC, Mercaldo SF, Sandler KL, et al.","paperType":"observational","findings":["Among 48,364 ever smokers, 32,463 (67 percent) were African American and 15,901 (33 percent) were white, with 1,269 incident lung cancers.","5,654 of 32,463 African American smokers (17 percent) were eligible for screening under the 2013 criteria, against 4,992 of 15,901 white smokers (31 percent).","The authors conclude that the guidelines may be too conservative for African American smokers and that race-specific adjustment of pack-year criteria would give more equitable screening."],"whatItMeans":"The clearest published demonstration that a screening eligibility rule can be accurate on average and systematically wrong for a group. It is the empirical core of the argument for replacing pack-year thresholds with individual risk models.","caveats":["A single regional cohort of community health centre attenders; eligibility fractions are not national estimates.","Self-reported smoking histories from follow-up questionnaires.","It evaluates eligibility, not screening outcomes: nobody in the cohort was randomised to be screened."],"changedPractice":true,"participants":48364},"route":"/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/","neighbours":{"paper":[{"id":"paper-nlst-nejm-2011","kind":"paper","name":"NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers","route":"/key-papers/paper-nlst-nejm-2011/"},{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/"}],"idea":[{"id":"idea-lung-screening-eligibility-by-risk-not-pack-years","kind":"idea","name":"Decide who is screened for lung cancer by individual risk, not by pack-years","route":"/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/"},{"id":"idea-prev-lung-screening-risk-model-eligibility","kind":"idea","name":"Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers","route":"/ideas/idea-prev-lung-screening-risk-model-eligibility/"},{"id":"idea-prev-mobile-lung-screening-deprived-areas","kind":"idea","name":"Take lung screening scanners to supermarket car parks in the poorest areas","route":"/ideas/idea-prev-mobile-lung-screening-deprived-areas/"},{"id":"idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","kind":"idea","name":"Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured","route":"/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"low-dose-ct-screening","kind":"technology","name":"Low-dose CT lung screening","route":"/technologies/low-dose-ct-screening/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"journal":[{"id":"jama-oncology","kind":"journal","name":"JAMA Oncology","route":"/journals/jama-oncology/"}],"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}]}}