Researchers call for revision of pack-year smoking history as screening parameter, calling it imperfect and biased
Harvard researchers have called for a change in the parameters for assessing lung cancer risk based on how many cigarettes a person has smoked each day, basing it instead on the duration of the smoking habit.
Calling the current practice of evaluating lung cancer risk by pack-year smoking history an imperfect and biased measure of cumulative tobacco exposure, they have pointed out that the benchmark leads to different results in people of different races. “Use of a 20-year smoking duration cutoff instead of a 20-pack-year cutoff greatly increases the proportion of patients with lung cancer who would qualify for screening and eliminates the racial disparity in screening eligibility between Black versus White individuals; smoking duration has the added benefit of being easier to calculate and being a more precise assessment of smoking exposure compared with pack-year smoking history,” they wrote in the Journal of Clinical Oncology.
The current recommendation in the US is to test all 50 to 80-year-old adults for lung cancer if they have been smoking at least 20 cigarettes a day for at least a year (this is denoted as 20 pack-year) or have quit smoking within the last 15 years.
“Our proposed guideline—which uses a 20-year smoking duration cutoff instead of a 20-pack-year smoking history cutoff—has several important advantages. First, use of the new cutoff increased the proportion of patients with lung cancer who would have qualified for screening to over 80% for both Black and White SCCS participants and 64% for Black women in the BWHS. Second, the proposed guideline eliminated the racial disparity in screening eligibility between Black versus White individuals,” the researchers wrote. SCCS refers to Southern Community Cohort Study and BWHS to the Black Women’s Health Study.
