ASPO Abstracts
Investigating Stage Shift for Lung Cancer After the Introduction of Screening Guidelines in the US
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
1. In 2013, the U.S. Preventive Services Task Force (USPSTF) began recommending lung cancer screening for
current and past smokers with at least 30 pack-years of exposure history. We sought to investigate if a stage
shift has occurred since the implementation of these guidelines and if disparities exist by race or geographical
region.
2. Data were obtained using Surveillance, Epidemiology, and End Results (Seer 21 Registry) from 2009 to 2016.
Incident lung cancer cases were extracted and stratified by stage, year of diagnosis, race (White and Black),
and geographical regions (West, Northeast, Northwest, Southwest, and Southeast).
3. 320,116 lung cancers diagnosed between 2009 and 2016. Among whites, the proportion diagnosed at stage
4 was 53.9% in 2009 and 48.4% in 2016 and the proportion diagnosed at stage 1 was 22.1% in 2009 and
28.1% in 2016. For blacks, the proportion diagnosed at stage 4 was 58.2% in 2009 and 54.7% in 2016 and the
proportion diagnosed at stage 1 was 17.6% in 2009 and 21.9% in 2016. We observed a percent decrease in
Stage 4 lung cancer diagnosis (10.2% decrease for Whites and 6.0% decrease for Blacks) and a slight relative
increase in Stage 1(27.1% increase for Whites and 24.4% increase for Blacks) for both Black and White
populations. In the Northeast region, proportions of stage 4 decreased more among Whites (13.0% vs 7.2%). In
the Southeast region, Blacks and Whites had comparable reductions in proportions of stage 4 diagnosis (3.1%
vs 3.0%).
4. Blacks are more likely to be diagnosed at a later stage overall and by region. Since the implementation of
screening guidelines, late stage lung cancer diagnosis has been decreasing for both races and all regions, but
not at the same rate by race or uniformly by geography.
This research was supported by NCI of NIH, award numbers: U54CA132384 & U54CA132379. The content is
the responsibility of the authors and does not represent the official views of the National Institutes of Health.
Keywords: Screening,Lung Cancer,Geography