Lung Screenings Based on Smoking Duration May Reduce Racial Disparities in Lung Cancer Detection

Smoking duration–based criteria may offer a viable alternative to pack-year based screening.

A large, prospective, and racially diverse study evaluating the effect of alternative eligibility criteria for lung cancer screening found that using smoking duration rather than pack-years reduced screening eligibility gaps among African Americans and Latinos relative to Whites. This screening approach also improved 6-year lung cancer detection sensitivity across all races, according to the study published in Annals of Internal Medicine.

In 2021, the United States Preventive Services Task Force (USPSTF) lowered lung cancer screening thresholds to 20 pack-years and age 50 to broaden screening eligibility and reduce racial disparities, but gaps remain because pack-years emphasize smoking intensity over duration.

Risk-based screening, already adopted internationally, has shown superior detection and reduced disparities, yet its performance compared to duration-based criteria in diverse U.S. populations has not been fully evaluated.

Researchers from Stanford University School of Medicine and colleagues analyzed data for 105,261 adults aged 45–75 years with a smoking history in California and Hawaii who were enrolled in the Multiethnic Cohort Study from 1993 to 1996 to evaluate screening eligibility and prognostic performance of alternative smoking-duration-based criteria vs USPSTF-2021 (≥20 pack-years) and risk-based screening using the recalibrated PLCOm2012_update (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012) model.

They found that under USPSTF-2021 criteria, 24% of participants were eligible for screening, with lower rates among African Americans and Latinos compared with Whites. Duration-based criteria increased eligibility for African Americans and Latinos while maintaining similar overall eligibility. Detection sensitivity improved under duration-based criteria, though specificity decreased slightly.

Risk-based screening achieved the highest overall sensitivity and specificity but widened eligibility gaps between Latinos and Whites and showed lower sensitivity for Latinos. These findings suggest that smoking duration–based criteria may offer a viable alternative to pack-year based screening, while risk-based approaches may require refinement to ensure equity.