Faculty Collaboration Database

Racial Differences in Outcomes within the National Lung Screening Trial. Implications for Widespread Implementation. Am J Respir Crit Care Med 2015 Jul 15;192(2):200-8

Date

05/01/2015

Pubmed ID

25928649

DOI

10.1164/rccm.201502-0259OC

Scopus ID

2-s2.0-84938056837 (requires institutional sign-in at Scopus site)   113 Citations

Abstract

RATIONALE: 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.

OBJECTIVES: Examine results of the NLST by race.

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

MEASUREMENTS AND MAIN 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.

Author List

Tanner NT, Gebregziabher M, Hughes Halbert C, Payne E, Egede LE, Silvestri GA

Author

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Female
Humans
Lung
Lung Neoplasms
Male
Mass Screening
Middle Aged
Tomography, X-Ray Computed
United States