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Rafael Meza
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OA06 - Refining Lung Cancer Screening (ID 131)
- Event: WCLC 2019
- Type: Oral Session
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:Tomasz Grodzki, Lluis Esteban Tejero
- Coordinates: 9/09/2019, 11:00 - 12:30, Hilton Head (1978)
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OA06.02 - The Role of Simulation Modeling in Shaping Lung Cancer Screening Policies in the US and Elsewhere (Now Available) (ID 1012)
11:00 - 12:30 | Presenting Author(s): Rafael Meza
- Abstract
- Presentation
Background
Models of the natural history of cancer have played an important role in shaping cancer prevention and control policies across the world. Notably, the US National Cancer institute (NCI) Cancer Intervention and Surveillance Modeling Network (CISNET) consortium has developed multiple such models and a modeling infrastructure that has supported the development of guidelines and policies for cancer screening and tobacco control in the US and elsewhere.
Method
The CISNET Lung models incorporate and synthetize smoking and lung cancer data from clinical trials, epidemiological studies and surveillance systems. These models have informed US screening guidelines. But important questions remain as screening programs are being implemented, such as the relative effectiveness of risk-based versus pack-year eligibility strategies or the potential of cessation programs within the context of lung screening.
Result
Simulation of the US 1950 and 1960 birth-cohorts show that for a given number of screens, risk-based screening programs lead in general to higher mortality reductions than pack-year based strategies. This is also true for LYG, but the difference is less pronounced. Independently of the program, adding cessation interventions at the point of screening leads to considerable gains in LYG, and to a lesser effect on deaths prevented. E.g., under current guidelines and a 40% screening uptake scenario, adding a cessation intervention at the time of first screen with a 15% success probability, could increase LYG by 140% and lung cancer deaths prevented by 28% (fig). But the actual gains would greatly depend on coverage and the cessation probability (fig).
Conclusion
Simulation modeling provides a framework to extrapolate findings from clinical trials and epidemiological studies into population outcomes. This has shown to be key to be able to refine and identify lung cancer prevention optimal strategies for a given setting. And to gather support among stakeholders to adopt and implement such strategies.
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OA09 - Lung Cancer: A Preventable Disease? (ID 134)
- Event: WCLC 2019
- Type: Oral Session
- Track: Prevention and Tobacco Control
- Presentations: 1
- Now Available
- Moderators:Bienvenido Barreiro, Carolyn Dresler
- Coordinates: 9/09/2019, 11:00 - 12:30, Melbourne (1991)
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OA09.03 - Patterns of Birth Cohort-Specific Smoking Histories by Family Income in the USA, 1982-2017 (Now Available) (ID 2734)
11:00 - 12:30 | Author(s): Rafael Meza
- Abstract
- Presentation
Background
Although cigarette smoking has been declining significantly in the US over last several decades, disparities in tobacco use remain across different groups by race/ethnicity, education, socioeconomic status (SES), or regions. Specifically, people in lower family income have higher smoking prevalence, longer smoking durations and lower cessation rates than other income groups. However, little is known about how smoking patterns, including rates of initiation, cessation, and intensity, differ by birth cohort across various income levels.
Method
Using the National Health Interview Survey (NHIS) family income data, we calculated individual income-to-poverty ratios from 1982-2017. Missing family income data from 1982-1996 was imputed using a sequential regression multivariate imputation method, the NHIS approach to impute missing continuous income from 1997-2017. Age-period-cohort models with constrained natural splines were used to estimate the annual probabilities of smoking initiation, cessation, and intensity by sex and birth-cohort for five income-to-poverty ratio groups (<1, 1-2,2-3,3-4 and 4+ times the poverty threshold). Age- and sex-specific smoking prevalence was also estimated for different income groups and birth cohorts.
Result
Smoking prevalence and initiation rates are decreasing by birth-cohort in all income-to-poverty ratio groups, while cessation rates are increasing. However, the relative smoking prevalence between low- and high-income groups is markedly increasing by birth-cohort (Figure 1). Smoking initiation probabilities are highest among those living below the poverty threshold, and inversely associated with income level. Conversely, people living below the poverty threshold have the lowest probabilities of quitting, with increasing smoking cessation probabilities in higher income groups. Age-specific smoking cessation probabilities vary considerably by income, especially in recent birth-cohorts for both men and women.
Figure 1. Age-specific current smoker prevalence for females (upper panels) and males (lower panels) for five income-to-poverty ratio groups (<1, 1-2,2-3,3-4 and 4+ times the poverty threshold) and selected birth cohorts.
Conclusion
Smoking prevalence has been decreasing in all income groups, however, disparities in smoking pattern between high and low-income populations are increasing with more recent birth-cohorts. Future studies evaluating disparities in smoking should account for differences by birth-cohort. The establishment of effective smoking intervention strategies specifically for low-income groups will be important to reduce tobacco-related health disparities.
Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.10 - Prevention and Tobacco Control (ID 175)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Prevention and Tobacco Control
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.10-01 - Patterns of Birth Cohort-Specific Smoking Histories by Race and Ethnicity in the US, 1965-2017 (ID 2680)
09:45 - 18:00 | Presenting Author(s): Rafael Meza
- Abstract
Background
Smoking prevalence varies greatly by race and ethnicity in the US. However, little is known about how smoking prevalence or the rates of initiation and cessation vary by birth cohort among different sociodemographic groups.
Method
Data from the National Health Interview Survey 1965-2017 were utilized to obtain smoking-related information for U.S. adults. We developed age-period-cohort models with constrained natural splines to estimate smoking prevalence among different racial/ethnic groups; non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), Hispanics, American Indians and Alaskan Natives (AIAN), and Asians and Pacific Islanders (API). Annual probabilities of smoking initiation, cessation and intensity by age, birth cohort (1890-1990), sex, and race/ethnicity were also estimated.
Result
Age-specific probabilities of smoking initiation were highest among AIAN, second highest among NHW and lowest among API and Hispanics (Fig1). Initiation probabilities among NHB were comparable in the past to NHW’s, but have decreased relatively more rapidly in recent birth cohorts. In general, cessation probabilities were lowest among AIAN and NHB, and highest among NHW and API across birth cohorts and ages. Taken together the initiation and cessation probabilities result in the observed race/ethnicity patterns of smoking prevalence by race/ethnicity, birth-cohort and age (Fig2), where for instance prevalence among AIAN is generally highest across all ages and birth cohorts. Or where prevalence among NHB, particularly men, is lower than that in NHW for young ages but higher for older ages.
Conclusion
This study explored in depth historical smoking patterns by race/ethnicity in the US, identifying important differences not only in prevalence, but also on cohort- and age-specific initiation and cessation rates. These differences need be taken into account when planning tobacco control interventions. Among the demographic groups analyzed, AIANs remain as the group with the highest smoking prevalence and initiation and the lowest cessation rates, and thus deserve specific interventions.
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P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-03 - Disparities and National Lung Cancer Screening Guidelines in the U.S. Population (ID 1496)
09:45 - 18:00 | Author(s): Rafael Meza
- Abstract
Background
Current U.S. Preventive Services Task Force (USPSTF) lung cancer (LC) screening guidelines are based on smoking history and age (55-80). These guidelines may miss those at higher risk, even at younger ages, due to other risk factors such as race or family history. In this study, we characterize the demographic/clinical profiles of those who are selected by risk-based screening criteria, but missed by USPSTF in younger (45-54) or older ages (71-80).
Method
We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and logistic prediction models for non-smoking risk factors to simulate life-time LC risk-factor data for 100,000 men and women in the U.S. 1950-1960 birth cohorts. We calculated age-specific 6-year LC risk (r) for each individual from ages 45-90 using the PLCOm2012 model. We evaluated age-specific screening-eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3%-2.5%).
Result
In the 1950 cohort, 6.73% would be missed for screening in their younger ages by the USPSTF-criteria, but would have been screened by the risk-based criteria. Similarly, 13.97% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, a higher proportion of African Americans will be ineligible for screening by USPSTF at younger (25.6%) or older (19.7%) ages, which is significantly higher than for Whites (7.7% and 15.75% respectively). Similar results were observed for other risk thresholds and for the 1960 cohort.
Conclusion
Further consideration is needed to incorporate comprehensive risk factors, including race/ethnicity, into lung screening criteria to reduce potential racial disparities.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-35 - Lung Cancer Screening Knowledge, Perceptions and Decision-Making Among African Americans (ID 2007)
10:15 - 18:15 | Presenting Author(s): Rafael Meza
- Abstract
Background
Significant lung cancer disparities exist in the USA, where African American men have the highest incidence rate. However, most available web-based lung cancer screening decision aids have been designed without substantive feedback from African Americans, and few have been validated in this population. Therefore, we sought to evaluate and redesign an existing decision aid with input from African Americans in Detroit.
Method
Using insights obtained from participatory design workshops in this population, we implemented content changes to shouldiscreen.com and evaluated this modified version with a before-after study. Surveys took place between April and July 2018. Data were collected from 78 participants who were current/former smokers, had no history of lung cancer, and aged between 45 and 77. Participants were contacted six months after to assess if they took steps to receive lung cancer screening.
Result
Knowledge about risk factors and screening between before and after viewing the decision aid was 6.4 and 8 out of 15 points, respectively (25% increase). Notably, half of the participants felt uncomfortable answering surveys electronically and requested paper versions. There was a 31% improvement in knowledge score among those who took the electronic survey (6.7 to 8.8), and 18% for paper (6.1 to 7.2). Acceptability was high: 93% of all participants said the tool helped them consider screening. Concordance between individual preference and eligibility for screening increased from 22% to 34% (n = 74). The primary source of discordance was from those who should not be screened but prefer to be screened, although the largest improvement came from those who were unsure. There was significant loss to follow-up at six months: only 14 out of 78 participants were successfully contacted. Of these, three were eligible for screening according to USPSTF criteria. Five followed up with their physicians, and the three who were eligible were strongly encouraged to be screened. Two went through with lung cancer screening and one had quit smoking.
Conclusion
Use of the tool led to improvements in lung cancer screening knowledge and concordance with current recommendations. Additional design modifications and modes of information delivery of current decision aids should be considered to increase their efficacy in helping populations with lower educational attainment and computer literacy. Partnering with community organizations and community leaders to demonstrate the use of the tool and explain the benefits of screening is paramount to help encourage those who might benefit most from it.
