EPR23-076: Demographic Changes of Expanded 2021 Lung Cancer Screening Guidelines in a Large National Database

Background: In March 2021, the US Preventative Services Taskforce expanded lung cancer screening eligibility to lower the minimum age from 55 to 50 years and minimum smoking history from 30 to 20 pack-years. The update aimed to increase the percentage of eligible individuals by 86% with a special emphasis on women and racial/ethnic minorities, groups that develop lung cancer at an earlier age and with lower smoking histories. Limited data exist to describe the impact of these expanded guidelines. A single institution study applied the 2013 and 2021 screening criteria to patients screened for lung cancer and found that more African Americans were screened using the expanded criteria. It is unknown how these guidelines have performed at a national level. Methods: This is a retrospective review of diagnosis and procedure codes from TriNetX database, which provides clinical information from 68 health care organizations (HCO) across the US. The period from August 1, 2020 to February 28, 2021 was used as the comparison cohort for the 2013 guidelines; August 1, 2021 to February 28, 2022 was used for the comparison cohort for the 2021 guidelines. Adults (>18 years old) with a procedure code for low dose CT scan for lung cancer screening during each respective timeframe and no prior history of lung cancer were included. Descriptive statistics were used to describe demographic characteristics. Results: A total of 10,580 patients met selection criteria for the 2013 guidelines cohort and 33,688 patients met criteria for the 2021 guidelines cohort. The percentage of patients identified as white (77.9% vs 78.6%; p = 0.125) and black or African American (13.6% vs 14.2%; p = 0.142) was not significantly different between the cohorts. Additionally, there was no significant difference in the percentage of female patients (48.3% vs 48.6%; p = 0.556). Patients in the expanded age range of 50–54 represented 3.7% of the 2021 cohort. Conclusions: This study found a large difference in the number of patients screened in the two cohorts from TriNetX. This difference is likely due to an increase in the number of HCOs contributing data as time passed and COVID-19 pandemic effects on healthcare utilization. This study found no significant difference in racial or gender characteristics of patients who completed lung cancer screening. More research is needed to further characterize how the updated screening guidelines may affect disparities in lung cancer screening.