J Clin Oncol

Is it time to rethink ‘pack-year’ smoking history for lung cancer screening eligibility?

April 10, 2024

Compared with a 20-pack-year cut off, use of a 20-year smoking duration cutoff substantially increases the proportion of patients with lung cancer who would qualify for screening and eliminates racial disparity in screening eligibility between Black vs. White individuals. In addition, smoking duration is easier to calculate and is a more precise assessment of smoking exposure compared with pack-year smoking history.

Researchers analyzed 49,703 individuals with a smoking history from the Southern Community Cohort Study (SCCS) and 22,126 individuals with a smoking history from the Black Women's Health Study (BWHS) to assess eligibility for screening using a proposed guideline that replaces USPSTF’s current ≥20-pack-year criterion with a ≥20-year smoking duration cutoff.

Using the current USPSTF guideline, only 57.6% of Black patients with lung cancer in the SCCS would have qualified for screening, compared with 74.0% of White patients with lung cancer (P < .001). Using the proposed guideline, the percentage of Black and White patients with lung cancer who would have been screen-eligible increased to 85.3% and 82.0%, respectively, effectively eradicating the disparity between the groups. In the BWHS, using a 20-year smoking duration cutoff rather than a 20-pack-year cutoff increased the percentage of Black women with lung cancer who would have been screen-eligible from 42.5% to 63.8%.

Source:

Potter AL, et al. (2024, March 27). J Clin Oncol. Pack-Year Smoking History: An Inadequate and Biased Measure to Determine Lung Cancer Screening Eligibility. https://pubmed.ncbi.nlm.nih.gov/38537159/