WCLC 2025 - Posters & ePosters-P3.01.01 Asian-Americans With Tobacco Use History Are Less Often Eligible for Screening Than White Individuals With Lung Cancer

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This study examines lung cancer screening (LCS) eligibility disparities between Asian-American and White patients with a history of tobacco use. Utilizing data from Jefferson Health (Philadelphia) and Weill Cornell Medicine (New York City), researchers analyzed lung cancer cases diagnosed from 2010 to 2024, excluding never-smokers. Data extraction combined electronic health records (EHR) and AI-driven natural language processing (NLP) to capture detailed smoking histories.<br /><br />Key findings reveal that Asian-American lung cancer patients, compared to White patients, tend to be younger, predominantly male, have lower smoking intensity (fewer pack-years), shorter quit durations, and lower rates of comorbidities like COPD. Despite similar smoking durations, Asian-Americans had significantly lower quit-years (8.5 vs. 15.1 years). Under current USPSTF criteria, differences in screening eligibility were minimal (USPSTF 2013: 32.3% Asian vs. 32.2% White; USPSTF 2021: 40.9% vs. 38.7%), but overall sensitivity was low (32-40%). Modifying criteria by replacing pack-years with smoking duration (e.g., 10- or 20-year thresholds) improved eligibility especially among Asian-Americans, increasing sensitivity to over 50%. The more inclusive ACS 2023 criteria, which remove the quit-year restriction, increased screening sensitivity to nearly 60% for Asian-Americans but revealed larger racial disparities (56.3% Asian vs. 62% White).<br /><br />Screening ineligibility was frequently linked to insufficient smoking intensity or quit years, with Asian Americans more commonly excluded due to pack-year criteria, while Whites were more often excluded due to quit-year criteria. These differences underscore how smoking pattern heterogeneity influences screening eligibility.<br /><br />The authors conclude that current USPSTF criteria may inadequately capture lung cancer risk for Asian-Americans, contributing to under-screening. They advocate for tailored, comprehensive approaches incorporating alternate metrics (such as smoking duration) and broader risk factors to enhance equitable LCS access and uptake among underserved populations. Further research should consider Asian-American subgroup variations and additional non-smoking risk factors to optimize screening guidelines.

Asset Subtitle

Julie Barta

Meta Tag

Speaker Julie Barta

Topic Risk Factors, Risk Reduction & Tobacco Control

Keywords

lung cancer screening

Asian-American health disparities

smoking history

USPSTF criteria

pack-years

smoking duration

screening eligibility

electronic health records

natural language processing

racial disparities in healthcare