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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.
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.
The 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.
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.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Trials do not represent the people who get cancer and the tag lung-evidence.
Shares Take lung screening scanners to supermarket car parks in the poorest areas, Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, 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, Fragmented care and guideline gaps and the tag lung-evidence.
Shares NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers, Low-dose CT lung screening, 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, The hardest cancers are found late and the tag lung-evidence.
Shares Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement, Low-dose CT lung screening, 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, Trials do not represent the people who get cancer and the tag lung-evidence.
Shares 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, The hardest cancers are found late, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares 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, The hardest cancers are found late, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares 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, Fragmented care and guideline gaps, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.
Shares 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, The hardest cancers are found late, Lung cancer (all types), Non-small-cell lung cancer and the tag lung-evidence.