Racial Differences in Outcomes within the National Lung Screening Trial. Implications for Widespread Implementation.
BACKGROUND
Black individuals with lung cancer (LC) experience higher mortality because they present with more advanced disease and are less likely to undergo curative resection for early-stage disease. The National Lung Screening Trial (NLST) demonstrated improved LC mortality by screening high-risk patients with low-dose computed tomography (LDCT). The benefit of LDCT screening in black individuals is unknown.


OBJECTIVE
Examine results of the NLST by race.


METHODS
This was a secondary analysis of a randomized trial (NCT00047385) performed in 33 U.S. centers.


RESULTS
Overall and lung cancer-specific mortality were measured. Screening with LDCT reduced LC mortality in all racial groups but more so in black individuals (hazard ratio [HR], 0.61 vs. 0.86). Smoking increased the likelihood of death from LC, and when stratified by race black smokers were twice as likely to die as white smokers (HR, 4.10 vs. 2.25). Adjusting for sociodemographic and behavioral characteristics, black individuals experienced higher all-cause mortality than white individuals (HR, 1.35; 95% confidence interval, 1.22-1.49); however, black individuals screened with LDCT had a reduction in all-cause mortality. Black individuals were younger, were more likely to be current smokers, had more comorbidities, and had fewer years of formal education than white individuals (P < 0.05).


CONCLUSIONS
Black individuals screened with LDCT had decreased mortality from lung cancer. However, the demographics associated with improved LC survival were less commonly found in black individuals. The overall mortality in the NLST was higher for black individuals than white individuals, but improved in black individuals screened, suggesting that this subgroup may have had improved access to care. To realize the reductions in mortality from LC screening, dissemination efforts need to be tailored to meet the needs of this community.
1 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina; and.|2 Division of Pulmonary and Critical Care Medicine.
Nichole T
http://orcid.org/0000-0003-3768-1973
NT
Tanner
1 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina; and.|3 Department of Public Health Sciences.
Mulugeta
M
Gebregziabher
1 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina; and.|4 Department of Psychiatry and Behavioral Sciences.|5 Hollings Cancer Center, and.
Chanita
C
Hughes Halbert
3 Department of Public Health Sciences.
Elizabeth
E
Payne
1 Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina; and.|6 Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
Leonard E
LE
Egede
2 Division of Pulmonary and Critical Care Medicine.
Gerard A
GA
Silvestri
D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000208:ethnology*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
lung cancer screening; mortality; race