Could scanning more blacks increase the benefits of lung screening?

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In a secondary analysis of data from the National Lung Screening Trial (NLST), a research team led by Dr. Ashley Prosper of the David Geffen School of Medicine at the University of California, Los Angeles estimated the results of cancer screening for lung by CT by creating hypothetical screening populations with varying distributions of black individuals, women, and current smokers.

The group found that CT lung screening could offer an even greater reduction in lung cancer mortality if the percentage of black participants was increased to reflect the share of black individuals in the overall U.S. population.

“The potential to achieve greater reductions in lung cancer mortality than initially estimated by the NLST with the inclusion of more black participants underscores the critical importance of improving access to screening lung cancer for current and former black smokers, ”the authors wrote.

While the benefits of CT lung screening are now generally well accepted, the arguments for its importance to black people who are currently or former smokers are largely based on reviews of clinical screening programs, according to the report. Researchers.

“These descriptive analyzes provide important information about the effects of screening in eligible black participants, but clinical trials remain the standard endpoint in evaluating the effectiveness of clinical interventions,” the authors wrote.

As a result, Prosper and his colleagues sought to estimate how CT lung screening might affect lung cancer and all-cause mortality in populations with a higher proportion of black screening participants than NLST. Using a technique called transportability analysis, they estimated results among hypothetical populations by varying the distribution of black individuals, females, and current smokers.

In the original NLST study, 4.4% of the study population was black, well below the percentage of blacks in the general American population. The researchers found that increasing the percentage of black participants in a hypothetical CT lung screening population to 13.4% – which is equivalent to U.S. Census data – resulted in a greater reduction in lung cancer mortality.

Improved lung cancer mortality with LDCT screening
NLST trial as a whole (4.4% of black participants) A hypothetical screening population in which 13.4% were black
Hazard ratio for lung cancer mortality 0.84 0.8

Additionally, the team found that the mortality risk ratio dropped further to 0.68 in a hypothetical population with a higher proportion of males or current smokers, as well as a higher proportion (60%, of which 20% to 40% of women) of Black people.

“Even with the myriad barriers to enrollment and ultimately adherence to lung screening with LDCT, the extrapolation of NLST results to various populations with increased proportions of black screening participants is nonetheless encouraging,” the authors concluded. . “The potential to further reduce lung cancer

mortality than that originally estimated by the NLST with the inclusion of more black participants underscores the critical importance of working to improve access to lung cancer screening for current and former smokers. “

In an accompanying editorial, Dr Christopher Lathan of the Dana-Farber Cancer Institute in Boston said the research is elegant and thought-provoking.

“Now we just need the will to build our trials and interventions to prospectively include historically marginalized communities even when there is no global pandemic and to maintain this awareness of systemic inequity at the grassroots level. future, ”Lathan wrote. “Lives depend on it.”

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