ASPO Abstracts
Racial Differences of Lung-RADS among Patients Enrolled in a Lung Cancer Screening Program
Category: Cancer Health Disparities, Electronic Health Records (EHRs)
Conference Year: 2018
Abstract Body:
Cancers of the lung and bronchus are responsible for nearly 30% of all cancer deaths in the U.S. While lung cancer incidence and mortality rates have decreased for all races over the past 20 years, major disparities persist among black and white patients with early stage lung cancer. The National Lung Screening Trial (NLST) demonstrated that annual low-dose computerized tomography (LDCT) screening reduced lung cancer mortality by 20% among high-risk smokers. A secondary analysis of the NLST, which included 4% black individuals, found that screening with LDCT had a greater impact on reduction of lung cancer mortality in blacks than in whites. But there is little knowledge about the impact of race on lung nodule malignancy in high-risk patients. The purpose of this study is to examine racial differences in lung malignancy among high-risk smokers. Retrospective data from the Jefferson Lung Cancer Screening Program were reviewed for patients referred to the Program between May 2015 and July 2017. Patient demographics (age, gender, race/ethnicity), BMI, medical and family history, smoking variables, and results of LDCT were extracted from the electronic medical record. Lung nodule malignancy was measured by Lung-RADS (0=1 & 2 for negative; 1=3, 4A, 4B & 4X for positive screening). Over a 2-year period, of 733 patients referred to the Program, 518 met eligibility criteria and underwent LDCT screening. 203 patients (39%) self- identified as Black, and 279 (53.6%) were White. About 14% of patients (n= 74) had a positive screen. There was a statistically significant racial difference in the distribution of lung-RADS 4 (15% for blacks vs. 4.1% for whites, p = 0.02). After adjusting for covariates, race was associated with lung-RADS: African Americans were more likely to have positive screening than whites (aOR=1.74, 95% CI, 1.02-2.98). In addition, females were less likely to have positive screening than males (aOR=0.48, 95% CI, 0.28-0.82). African Americans had higher odds of a positive screen than whites. Risk factors to explain higher lung nodule malignancy among African Americans may include genetics, SES, alcohol consumption, and/or access to care. Continued research efforts are needed to determine the contribution of other factors to lung cancer disparities.
Keywords: racial differences; Lung nodule malignancy; LDCT screening