Evaluating the Feasibility of Lung Cancer Screening in High-Risk Black Women

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PROJECT SUMMARY. Every year, approximately 6,800 and 37,000 Black women in the United States die from lung cancer and cardiovascular diseases, respectively. Most Black women diagnosed with lung cancer and cardiovascular diseases are diagnosed at advanced stages, which are associated with significantly higher mortality and greater healthcare-related costs. As such, strategies to increase the early detection of lung cancer and cardiovascular diseases among Black women are urgently needed. Lung cancer screening with low-dose computed tomography (LDCT) has been shown to result in earlier detection of lung cancer and significant reductions in lung cancer mortality in two large randomized trials. Additionally, research has shown that LDCT scans can be used to predict cardiovascular disease risk. Thus, LDCT lung cancer screening offers an opportunity to increase the early detection of lung cancer and cardiovascular diseases among Black women. However, while LDCT screening is recommended by the United States Preventive Services Task Force (USPSTF) for individuals classified as high-risk, current USPSTF screening eligibility criteria exclude many Black women who are actually high-risk but do not meet the criteria. In our previous study of participants in the Black Women’s Health Study (BWHS), we found that over 66% of Black women diagnosed with lung cancer would have been ineligible for lung cancer screening under the 2021 USPSTF guidelines. Lung cancer risk-prediction models can account for lung cancer risk factors other than age and smoking (e.g., COPD) and are a promising strategy to increase the number of high-risk Black women eligible for screening. However, the effectiveness of such models in selecting high-risk Black women for screening has never been studied prospectively. Given the tremendous potential for LDCT screening to increase the early detection of lung cancer and cardiovascular diseases, studies investigating more effective approaches for lung cancer screening among Black women are needed to enhance the benefits of screening among this population. Our overall objective is to conduct a single-arm (n=400) pilot study of U.S. Black women participating in the BWHS—a cohort of 58,973 self-identified Black women from across the U.S.—to examine the feasibility, acceptability, and performance of LDCT screening among this population. We will recruit Black women aged > 50 years with any history of smoking. We aim to 1) evaluate the feasibility and acceptability of LDCT screening among U.S. Black Women; 2) evaluate the performance of LDCT for lung cancer detection among our cohort and compare it to U.S. Black women in the National Lung Screening Trial (historical control), and 3) validate a deep learning image analysis pipeline for cardiovascular disease detection among our cohort. The findings of this pilot study will provide a strong foundation for a large-scale study that further evaluates the optimal risk-based screening strategies to select high-risk Black women for lung cancer screening. In addition, the findings of this pilot study will provide preliminary data that can be used to inform a future large-scale study using deep learning networks to predict cardiovascular risk on LDCT scans.