title: Do Lung Cancer Eligibility Criteria Align with Risk among Blacks and Hispanics?
abstract: BACKGROUND
  Black patients have higher lung cancer risk despite lower pack years of smoking. We assessed lung cancer risk by race, ethnicity, and sex among a nationally representative population eligible for lung cancer screening based on Medicare criteria.
  
  
  METHODS
  We used data from the National Health and Nutrition Examination Survey, 2007-2012 to assess lung cancer risk by sex, race and ethnicity among persons satisfying Medicare age and pack-year smoking eligibility criteria for lung cancer screening. We assessed Medicare eligibility based on age (55-77 years) and pack-years (≥ 30). We assessed 6-year lung cancer risk using a risk prediction model from Prostate, Lung, Colorectal and Ovarian Cancer Screening trial that was modified in 2012 (PLCOm2012). We compared the proportions of eligible persons by sex, race and ethnicity using Medicare criteria with a risk cut-point that was adjusted to achieve comparable total number of persons eligible for screening.
  
  
  RESULTS
  Among the 29.7 million persons aged 55-77 years who ever smoked, we found that 7.3 million (24.5%) were eligible for lung cancer screening under Medicare criteria. Among those eligible, Blacks had statistically significant higher (4.4%) and Hispanics lower lung cancer risk (1.2%) than non-Hispanic Whites (3.2%). At a cut-point of 2.12% risk for lung screening eligibility, the percentage of Blacks and Hispanics showed statistically significant changes. Blacks eligible rose by 48% and Hispanics eligible declined by 63%. Black men and Hispanic women were affected the most. There was little change in eligibility among Whites.
  
  
  CONCLUSIONS
  Medicare eligibility criteria for lung cancer screening do not align with estimated risk for lung cancer among Blacks and Hispanics. Data are urgently needed to determine whether use of risk-based eligibility screening improves lung cancer outcomes among minority patients.
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.|Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiscella
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Winters
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Subrina
authors.initials: S
authors.lastname: Farah
authors.affiliation: Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States of America.
authors.forename: Mechelle
authors.initials: M
authors.lastname: Sanders
authors.affiliation: Department of Medicine, Division of Oncology, University of Rochester Medical Center and the Wilmot Cancer Center, Rochester, NY, United States of America.
authors.forename: Supriya G
authors.initials: SG
authors.lastname: Mohile
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D004608:Eligibility Determination / Q000458:organization & administration*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D018570:Risk Assessment; D014481:United States / Q000208:ethnology