Lung cancer screening (LCS) can reduce lung cancer mortality by 20 to 50 percent. The national criteria developed by the US Preventive Services Task Force (USPSTF) recommend annual screening for adults aged 50 to 80 years with a significant smoking history, defined as at least 20 “pack-years.” This could be quantified as smoking 1 pack per day for 20 years, or 2 packs per day for 10 years. However, these criteria were developed using data from predominantly white populations and may miss high-risk individuals in other groups. Prior studies have shown that women and African American individuals can develop lung cancer at lower levels of smoking exposure and may therefore be excluded from screening. Evidence for Asian Americans has been particularly limited.
To examine this gap, Dr. Eunji Choi, assistant professor of population health sciences, and colleagues combined two lung cancer datasets: the Molecularly Enhanced Lung Cancer Database (MELD), developed through collaboration between the Division of Epidemiology, Research Informatics, and the Sandra and Edward Meyer Cancer Center, and a Jefferson Health lung cancer cohort. The team compared how many Asian American and white patients with lung cancer would have been eligible for screening under the national USPSTF criteria and alternative criteria. Within Asian Americans, they also considered differences in acculturation. Acculturation was defined by preferred language. Patients who preferred English were categorized as highly acculturated, and those preferring other languages were categorized as less acculturated.
Published in the American Journal of Respiratory and Critical Care Medicine, this study found that highly acculturated Asian American patients were significantly less likely than white patients to meet screening eligibility, even at the time of lung cancer diagnosis. This was true for patients who were younger and more likely to present with advanced-stage disease. In contrast, less acculturated Asian Americans had higher smoking exposure, in part due to continued heavier smoking patterns from their countries of origin, and did not show the same eligibility gap compared with white patients. However, language and cultural barriers may still limit actual screening uptake in this group. Importantly, replacing the 20 pack-year threshold with a 20-year smoking duration criterion in LCS eligibility criteria reduced the eligibility gap between acculturated Asian American and white patients.
Overall, these findings suggest that current screening criteria for lung cancer may miss high-risk Asian American individuals and highlight the need to refine eligibility definitions and improve culturally and linguistically tailored outreach to increase screening participation.
- Highlights