scholarly journals Using Prediction-Models to Reduce Persistent Racial/Ethnic Disparities in Draft 2020 USPSTF Lung-Cancer Screening Guidelines

2021 ◽  
Author(s):  
Rebecca Landy ◽  
Corey D Young ◽  
Martin Skarzynski ◽  
Li C Cheung ◽  
Christine D Berg ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
African Americans ◽  
Asian Americans ◽  
Prediction Models ◽  
Hispanic Americans ◽  
Ethnic Disparities ◽  
Lung Cancer Screening ◽  
Life Years ◽  
Racial Ethnic

Abstract We examined whether draft 2020 United States Preventive Services Task Force (USPSTF) lung-cancer screening recommendations “partially ameliorate racial disparities in screening eligibility” compared to 2013 guidelines, as claimed. Using data from the 2015 National Health Interview Survey, USPSTF-2020 increased eligibility by similar proportions for minorities (97.1%) and Whites (78.3%). Contrary to the intent of USPSTF-2020, the relative disparity (differences in percentages of model-estimated gainable life-years from National Lung Screening Trial-like screening by eligible Whites vs minorities) actually increased from USPSTF-2013 to USPSTF-2020 (African Americans: 48.3%–33.4%=15.0% to 64.5%–48.5%=16.0%; Asian Americans: 48.3%–35.6%=12.7% to 64.5%–45.2%=19.3%; Hispanic Americans: 48.3%–24.8%=23.5% to 64.5%–37.0%=27.5%). However, augmenting USPSTF-2020 with high-benefit individuals selected by the Life-Years From Screening with Computed Tomography (LYFS-CT) model nearly eliminated disparities for African Americans (76.8%–75.5%=1.2%), and improved screening efficiency for Asian/Hispanic Americans, although disparities were reduced only slightly (Hispanic Americans) or unchanged (Asian Americans). Draft USPSTF-2020 guidelines increased the number of eligible minorities versus USPSTF-2013 but may inadvertently increase racial/ethnic disparities. LYFS-CT could reduce disparities in screening eligibility by identifying ineligible people with high predicted benefit, regardless of race/ethnicity.

Abstract PO-247: Use of prediction models to reduce racial/ethnic disparities in eligibility for lung-cancer screening

2020 ◽  
Author(s):  
Rebecca Landy ◽  
Corey D. Young ◽  
Martin Skarzynski ◽  
Li C. Cheung ◽  
Christine D. Berg ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Prediction Models ◽  
Ethnic Disparities ◽  
Lung Cancer Screening ◽  
Racial Ethnic

scholarly journals A Comparative Modeling Analysis of Risk-Based Lung Cancer Screening Strategies

2019 ◽  
Vol 112 (5) ◽  
pp. 466-479 ◽  
Author(s):  
Kevin ten Haaf ◽  
Mehrad Bastani ◽  
Pianpian Cao ◽  
Jihyoun Jeon ◽  
Iakovos Toumazis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Risk Prediction ◽  
Prediction Models ◽  
Lung Cancer Screening ◽  
Comparative Modeling ◽  
Risk Prediction Models ◽  
Life Years ◽  
Screening Strategies

Abstract Background Risk-prediction models have been proposed to select individuals for lung cancer screening. However, their long-term effects are uncertain. This study evaluates long-term benefits and harms of risk-based screening compared with current United States Preventive Services Task Force (USPSTF) recommendations. Methods Four independent natural history models were used to perform a comparative modeling study evaluating long-term benefits and harms of selecting individuals for lung cancer screening through risk-prediction models. In total, 363 risk-based screening strategies varying by screening starting and stopping age, risk-prediction model used for eligibility (Bach, PLCOm2012, or Lung Cancer Death Risk Assessment Tool [LCDRAT]), and risk threshold were evaluated for a 1950 US birth cohort. Among the evaluated outcomes were percentage of individuals ever screened, screens required, lung cancer deaths averted, life-years gained, and overdiagnosis. Results Risk-based screening strategies requiring similar screens among individuals ages 55–80 years as the USPSTF criteria (corresponding risk thresholds: Bach = 2.8%; PLCOm2012 = 1.7%; LCDRAT = 1.7%) averted considerably more lung cancer deaths (Bach = 693; PLCOm2012 = 698; LCDRAT = 696; USPSTF = 613). However, life-years gained were only modestly higher (Bach = 8660; PLCOm2012 = 8862; LCDRAT = 8631; USPSTF = 8590), and risk-based strategies had more overdiagnosed cases (Bach = 149; PLCOm2012 = 147; LCDRAT = 150; USPSTF = 115). Sensitivity analyses suggest excluding individuals with limited life expectancies (<5 years) from screening retains the life-years gained by risk-based screening, while reducing overdiagnosis by more than 65.3%. Conclusions Risk-based lung cancer screening strategies prevent considerably more lung cancer deaths than current recommendations do. However, they yield modest additional life-years and increased overdiagnosis because of predominantly selecting older individuals. Efficient implementation of risk-based lung cancer screening requires careful consideration of life expectancy for determining optimal individual stopping ages.

scholarly journals Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

2021 ◽  
Author(s):  
Christopher J Cadham ◽  
Pianpian Cao ◽  
Jinani Jayasekera ◽  
Kathryn L Taylor ◽  
David T Levy ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Cancer Registries ◽  
Web Based ◽  
Screening Programs ◽  
Life Years

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.

Voting Rights, Election Administration, and Turnout for Racial Minorities

2020 ◽  
pp. 91-110
Author(s):  
Michael Ritter
Keyword(s):  
African Americans ◽  
Ethnic Minorities ◽  
Asian Americans ◽  
Race And Ethnicity ◽  
Hispanic Americans ◽  
Election Administration ◽  
Midterm Elections ◽  
The Impact ◽  
Racial Ethnic ◽  
Over Time

Race and ethnicity group identity also shape participation in politics, with non-Hispanics whites being the most likely to vote in U.S. elections over time. Can accessible elections shrink turnout inequality between non-Hispanic whites and racial/ethnic minorities (African Americans, Hispanic Americans, and Asian Americans)? Chapter 6 empirically evaluates the impact of convenience voting laws and election administration on the change in the probably of voting in midterm and presidential elections comparing across racial subgroups. The results show that same day registration boosts turnout among non-Hispanics whites, as well as Asian Americans, Hispanics, and African Americans, in presidential and midterm elections. Early in-person voting especially advantages blacks and Hispanics in midterm elections, while absentee/mail voting is found to have similar effects for Asian Americans. Both non-Hispanic whites and racial and ethnic minorities benefit from quality state election administration.

Lung Cancer Screening Knowledge, Perceptions, and Decision Making Among African Americans in Detroit, Michigan

2021 ◽  
Vol 60 (1) ◽  
pp. e1-e8
Author(s):  
Yan Kwan Lau ◽  
Harihar Bhattarai ◽  
Tanner J. Caverly ◽  
Pei-Yao Hung ◽  
Evelyn Jimenez-Mendoza ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
African Americans ◽  
Lung Cancer Screening
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