Do Our Current Uspstf Guidelines For Lung Cancer Screening Fail Young, High-Risk African American Smokers?

SESSION TITLE: Modern Approaches to the Diagnosis of Lung Cancer Across Multiple Populations SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Lung cancer is the leading cause of cancer related deaths in men and women with 1.76 million deaths worldwide in 2018 with more than 80% deaths attributed to smoking. Given its high prevalence and mortality, trials were conducted to develop effective screening strategies in high-risk populations. In 2011, the National Lung Screening Trial showed a 20% relative risk reduction in mortality in people screened with Low Dose Chest CT (LDCT) contributing to the implementation of current USPSTF screening guidelines. However, the predominant focus on elderly, Caucasian questions its generalized applicability to communities with young, African-Americans such as our institution. Hence, the objective of our study is to investigate the need to modify the current screening guidelines practiced at our institution by assessing the applicability of newer individual risk-based prediction models for LDCT screening. METHODS: The study is designed as a retrospective observational cohort study of the new diagnoses at LSU Health Sciences Center Shreveport from 2011-2015. On charts review, a total of 980 patients met our inclusion criteria which consisted of patients 18 years or older diagnosed with lung cancer. Among these, 1/3rd of the patients did not meet the current USPSTF screening guidelines. We categorized these individuals into high-risk (groups 1 and 2), moderate risk, and low risk according to 2018 NCCN Lung Cancer Screening Guidelines Version 1.2020. To differentiate between high-risk group 2 and moderate risk, the Tammemagi lung cancer risk calculator was employed, considering ≥1.3% 6 year lung cancer risk probability as high risk group 2 and <1.3% as moderate risk. According to NCCN, high-risk group 1 and 2 are eligible for annual LDCT. RESULTS: Around 33% of lung cancer patients at our institution from 2011-2015 were diagnosed at <55 years, hence did not meet the current USPSTF screening guidelines. Out of these, nearly 50% were African American, 95% with known smoking history, and 80% diagnosed at advanced stages at the initial time of diagnosis. After employing the Tammemagi Risk based calculator in these individuals, 12.5% were categorized into high-risk group 2. CONCLUSIONS: The current USPSTF guidelines have failed in our population primarily consisting of young African-American smokers, questioning the health disparity in medicine. By employing individual risk based prediction models catering to our individual community demographics, we could potentially identify tailored high-risk populations leading to appropriate use of LDCT screening, contributing to early diagnosis and treatment and minimize the harms from unnecessary screening. CLINICAL IMPLICATIONS: We believe age is a limiting factor in current guidelines and new screening methods must be implemented, focusing on smoking history and population demographics. This could be achieved by employing individual risk based predictor models. DISCLOSURES: No relevant relationships by Jade Abad, source=Web Response No relevant relationships by kavitha Beedupalli, source=Web Response no disclosure on file for Constance Cole; No relevant relationships by Samina Hirani, source=Web Response no disclosure on file for Richard Mansour; no disclosure on file for Samip Master; No relevant relationships by Runhua Shi, source=Web Response No relevant relationships by Aswani Thurlapati, source=Web Response No relevant relationships by Carol Velez Martinez, source=Web Response