Using Prediction-Models to Reduce Persistent Racial/Ethnic Disparities in Draft 2020 USPSTF Lung-Cancer Screening Guidelines
Menée aux Etats-Unis à partir d'une version de travail des recommandations 2020 de l'"United States Preventive Services Task Force" concernant le dépistage des cancers du poumon, cette étude estime le bénéfice de ces recommandations en matière de réduction des inégalités ethniques par rapport aux recommandations 2013 et évalue l'intérêt d'un modèle prédictif pour identifier parmi les personnes inéligibles au dépistage celles qui devraient l'être
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.
Journal of the National Cancer Institute , article en libre accès, 2020