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8016 Background: LCS eligibility criteria are not optimal. US Preventive Services Task Force 2021 criteria (USPSTF21) expanded eligibility, but race and sex disparities persist. We evaluated how 4 modified criteria impact LCS eligibility. Methods: We analyzed data from all persons enrolled into LCS and a non-screening detected Lung Nodule Program (LNP) in a prospective community-based cohort. The LNP used Fleischner Society guidelines. We compared sex, race, and Area Deprivation Index (ADI) of LCS-eligible persons and LC patients diagnosed based on USPSTF21 (Age 50-80, 20 pack-years PY, 15 year quit duration QD) versus 4 more-relaxed smoking history criteria in LNP including the new American Cancer Society (ACS) criteria (Group 4, Table). Results: Of 38,740 individuals from 2015-2023, 11,886 had LCS and 26,854 were from LNP. Expanded criteria increased the total eligible over USPSTF21 from 3939, to 4572, 4611, 4950, 5747 in Groups 2-5, respectively. LC was detected in 3.7% of LDCT (17.4% of those with Lung-RADS 3/4), and in 21%, 20%, 19%, 19%, and 18% of LNP Groups 1-5; number needed to treat (NNT) was 26.8 (LDCT), 5.8 (LDCT Lung-RADS 3/4), and 4.9, 4.9, 5.2, 5.2, 5.5 in Groups 1-5. LC was most frequently adenocarcinoma (41-51%) or squamous (21-30%); with similar stage across groups (47-48% stage I/II). LC was diagnosed in 17%, 11%, 14%, and 13% of additional eligible persons vs. 21% in USPSTF21 (Table). The additional eligible individuals with LC were 42%, 58%, 40%, and 46% female in Groups 2-5. We compared % female in Group 3 with LNP (58 v 51%, p=.25) and LCS (58 v 52%, p=.22). In terms of race, additional eligible individuals were 11%, 47%, 10%, and 24% Black in Groups 2-5; with significant differences between Group 3 and both LNP (47 v 25%, p<.001) and LCS (47 v 16%, p<.001) cohorts. These groups (2-5) were 26%, 38%, 29%, and 33% in the highest (poorest) ADI quintile, with no differences between Group 3 and LNP (38 v 36%, p=.66) or LCS (38 v 42%, p=.56). Group 3 / 5 criteria yielded a 17% / 46% increase in persons screened, and a 9.5% / 28% increase in LC identified over USPSTF21. Conclusions: Relaxed smoking history requirements provided better access to LCS while maintaining diagnostic efficiency in terms of NNT. The shift from 20 PY to 20 years reduced race- and sex- based disparities in LCS eligibility and LC diagnosis, while still reaching the most socially disadvantaged groups. Table: see text
Smeltzer et al. (Sat,) studied this question.