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NAQC Newsroom: Research

Analysis of the 30-Pack-Year Smoking Threshold in African Americans From an Underserved Lung Cancer

Tuesday, January 19, 2021  
Posted by: Natalia Gromov
Basu A, Kopulos L, Geissen N, Sukhal S, Smith SB.
Analysis of the 30-Pack-Year Smoking Threshold in African Americans From an Underserved Lung Cancer Screening Program.
J Am Coll Radiol. 2021 Jan;18(1 Pt A):27-33. doi: 10.1016/j.jacr.2020.08.017. Epub 2020 Sep 16. PMID: 32946802.

Purpose. African Americans were underrepresented in lung cancer screening (LCS) trials, despite having higher lung cancer incidence and worse outcomes compared with Caucasians. There is concern that the 30-pack-year threshold excludes some African Americans who may benefit from LCS.
Methods. LCS in an underserved health care system was reviewed. Providers attested that patients met LCS criteria, including 30-pack-year history, but patients also self-reported smoking histories. Self-reported data were used to identify patients with <30-pack-year histories.
Results. Over 2 years, 784 patients self-reported sufficient data to calculate pack-years. The majority were men (57.5%), and 66.2% were African Americans. Median total years smoked was 40 (interquartile range, 30-45 years), and median pack-years was 25 (interquartile range, 15-40 pack-years). African Americans were more likely to report <30 pack-years compared with other races (P < .001). The overall incidence of lung cancer was 2.0%, and incidence was similar for those with ≥30 or <30 pack-years (2.1% versus 2.0%; odds ratio, 0.94; 95% confidence interval, 0.35-2.53; P = .902). Race was not associated with lung cancer diagnosis, but African Americans were the only race to have lung cancer if pack-years were <30. The incidence of cancer in African Americans was similar in those who reported ≥30 or <30 pack-years (2.2% versus 2.7%; odds ratio, 1.21; 95% confidence interval, 0.39-3.75; P = .740), and the 30-pack-year threshold was not associated with lung cancer diagnosis. 
Conclusions. This is the first review of LCS in African Americans who self-reported <30 pack-years. Although retrospective, these data raise concern that the 30-pack-year threshold may not be an appropriate LCS criterion in African Americans.

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