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Kevin L. Kovitz
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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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P1.11-06 - Expanding Criteria for Lung Cancer Screening Reduces Gender Disparity (ID 1517)
09:45 - 18:00 | Author(s): Kevin L. Kovitz
- Abstract
Background
Women smokers may be more susceptible to lung cancer with less cigarette exposure than men. The NLST found borderline greater mortality benefit to high-risk women screened for lung cancer than men. The NELSON trial found significantly greater mortality benefit for women than men (39-61% for women vs 26% in men at 10 years). Since the NELSON trial included individuals >50 years old and <20 pack-years smoking history (similar to the NCCN moderate risk group) the aim of this study was to evaluate a cohort of lung cancer patients to determine differences in meeting the USPSTF criteria versus the NCCN moderate risk criteria on the basis of gender.
Method
Gender, demographics, and smoking history were collected in a retrospective analysis of 703 smokers (current and former) diagnosed with lung cancer between 2010 – 2017 at an urban Chicago academic medical center. Cases were assessed for whether they would have met USPSTF (includes age 55-80, current smoker or former smokers quit time <15 years, >30 pack-years) and the NCCN moderate risk (includes age >50, current or former smokers, >20 pack-years) screening eligibility criteria.
Result
Women smoked less overall, were less likely to smoke >30 pack-years (p=0.0002) and less likely to meet USPSTF screening guidelines (46.7% women vs 61.0% of men, p=0.0007) than men (Table 1). This gender disparity in meeting eligibility criteria was reduced by >40% (from 14.4% to 8.0%) when expanding from USPSTF (61.0% men vs 46.7% woman) to the NCCN moderate risk criteria (80.7% men vs. 72.7% women). Women were diagnosed at an earlier stage than men (p=0.02).
Conclusion
Women diagnosed with lung cancer had a lighter smoking history and were less likely to meet the USPSTF screening criteria than men. Expanding USPSTF criteria to include individuals age >50 and >20 pack-year smoking history decreased the gender disparity in meeting lung cancer screening guidelines.
Table 1: Gender Variation in Lung Cancer Current and Former Smokers
Gender
p-value
Men
Women
Total N = 703 (%)
403 (57.33)
300 (42.67)
Age Mean (SD)
64.36 (9.55)
64.66 (9.15)
0.7284
Race/Ethnicity (%)
0.1341
Black, Non-Hispanic
215 (53.35)
182 (60.67)
White, Non-Hispanic
135 (33.50)
88 (29.33)
Hispanic/Other
53 (13.15)
30 (10.00)
Smoking History (%)
0.8515
Current
258 (64.02)
190 (63.33)
Former
145 (35.98)
110 (36.67)
Pack Years of Smoking Mean (SD)
45.33 (27.92)
36.02 (23.38)
0.0002
Pack Years of Smoking (%)
>30
305 (75.68)
181 (60.33)
20- 30
48 (11.94)
55 (18.33)
10-19
38 (9.43)
43 (14.33)
0.5-9
12 (2.99)
21 (7.00)
Quit-years for Former Smokers Mean (SD)
12.98 (11.04)
13.44 (11.93)
0.7497
Quit-years for Former Smokersa (%)
0.5-15
97 (68.79)
67 (62.04)
>15
44 (31.21)
41 (37.96)
Met Screening Criteria (%)
0.0007
USPSTF
246 (61.04)
140 (46.67)
NCCN moderate risk groupb minus those that met
USPSTF criteria
79 (19.60)
78 (26.00)
NCCN moderate risk groupb (includes USPSTF)
325 (80.65)
218 (72.67)
Did not meet USPSTF or NCCN
78 (19.35)
82 (27.33)
Stagec (%)
0.0224
I
51(13.28)
63 (22.26)
II
25 (6.51)
18 (6.36)
III
90 (23.44)
55 (19.43)
IV
218 (56.77)
147 (51.94)
aN=249 (number of former smokers with known quit-year data)
bNCCN moderate risk (age >50 with a smoking history of >20 pack years)
cN=667 (number of lung cancer cases with known staging data)
Abbreviations: NLST = National Lung Screening Trials; NELSON = Nederlands-Leuvens Longkanker Screening Network; USPSTF = United States Preventative Services Task Force; NCCN = National Comprehensive Cancer Network; N = number of cases; SD = Standard Deviation
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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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P2.11-22 - Comparison of the Sensitivity of USPSTF and PLCOm2012 Lung Cancer Screening Criteria in a Racially Diverse Population (ID 855)
10:15 - 18:15 | Author(s): Kevin L. Kovitz
- Abstract
Background
Objective: To compare the sensitivity to detect lung cancer of two lung cancer screening selection criteria, the USPSTF (≥30 pack-years smoked, quit-time ≤15 years, age 55-80) and the PLCOm2012 model 6-year risk ≥1.5%, in a racially diverse population including a high proportion of Blacks.
Method
Lung cancer cases diagnosed at a Chicago academic hospital in 2010–2017 were retrospectively analyzed for whether they met lung cancer screening eligibility using the USPSTF and PLCOm2012 criteria. Contingency table analysis with McNemar’s odds ratios, confidence intervals and p-values evaluated comparisons.
Result
The race/ethnic distribution of the 823 lung cancer cases was 245 (29.8%) Whites, 435 (52.9%) Blacks, 75 (9.1%) Hispanics, 39 (4.7%) Asians, and 29 (3.5%) others. Overall, data on criteria risk factors were available for 770 (93.6%) individuals: 68.3% were positive by PLCOm2012 criteria and 49.9% were positive by the USPSTF (Table 1, McNemar’s odds ratio (ORM)=11.9, 95%CI 6.8-22.9, p<0.0001). Limited to Blacks, the USPSTF criteria identified 50.8% and the PLCOm2012 identified 74.9%. Only 3 individuals were USPSTF+ve/PLCOm2012-ve and 104 individuals were PLCOm2012+ve/USPSTF-ve (Table 2, ORM=34.7, 95%CI 11.5-170.8, p<0.0001).
Overall and especially in Blacks, compared to the USPSTF criteria, the PLCOm2012 criteria was significantly more sensitive at identifying lung cancer patients.
Table 1. Lung cancer cases (N=770) stratified by USPSTF and PLCOm2012 selection criteria status, all races/ethnicities. Cells contain number, (row percent), [column percent].
PLCOm2012 risk < 1.5%
PLCOm2012 risk >1.5%
Total
USPSTF criteria -ve
231
(59.8%)
[94.7%]
155
(40.2%)
[29.5%]
386
(100.0%)
[50.1%]
USPSTF criteria +ve
13
(3.4%)
[5.3%]
371
(96.6%)
[70.5%]
384
(100.0%)
[49.9%]
Total
244
(31.7%)
[100.0%)
526
(68.3%)
[100.0%]
770
(100.0%)
[100.0%]
Table 2. Lung cancer cases (N=419) stratified by USPSTF and PLCOm2012 selection criteria status, Black race only. Cells contain number, (row percent), [column percent].
PLCOm2012 risk < 1.5%
PLCOm2012 risk >1.5%
Total
USPSTF criteria -ve
102
(49.5%)
[97.1%]
104
(50.5%)
[33.1%]
206
(100.0%)
[49.2%]
USPSTF criteria +ve
3
(1.4%)
[2.9%]
210
(98.6%)
[66.9%]
213
(100.0%)
[50.8%]
Total
105
(25.1%)
[100.0%)
314
(74.9%)
[100.0%]
419
(100.0%)
[100.0%]