Addressing racial disparities in lung cancer screening

项目摘要/摘要 筛查促进癌症的早期发现，以降低死亡率。不幸的是，严重的种族差距 存在于肺癌筛查中。我们团队最近发表的研究结果表明，在目前的国家 筛查指南非裔美国人与白人相比，降低了肺癌筛查的资格。 这些筛查指南是基于年龄和吸烟包年标准的组合，这些标准源于 主要(91%)为白色的国家肺部筛查试验。重要的是，吸烟行为和基线风险 对于肺癌，非裔美国人和白人有很大的不同。正因为如此，基于风险的筛查 与目前的筛查指南相比，战略可能提供更公平的资格评估。然而， 非洲裔美国人肺癌的个性化风险预测模型的开发一直受到限制。至 为了解决这一差距并提高筛查资格的公平性，我们建议建立一个个性化的预测工具 使用来自三个大规模基于人口的预期队列的合并数据，这些队列中大部分是非洲人 美国代表处。合并后的队列有超过336,000人(44%是非洲裔美国人)和 来自美国各地的9132例肺癌病例。我们提出了以下三个目标：1) 构建一个经过良好校准的肺癌风险自然历史模型，用于非裔美国人的筛查，2) 通过模拟评估肺癌筛查策略，并确定将受益于 筛查，说明合并症和假阳性，以及3)开发基于Web的决策辅助工具 在文化上合适的筛选。我们将采用创新的机器学习技术和最新的 ART统计方法，为非裔美国人建立一个校准良好的肺癌预测模型。小心 检查将确定亚群体(如妇女、低社会经济地位、农村、年龄组等)。 这项提议的一个关键创新方面是其社区参与的方法和 与社区咨询委员会的伙伴关系，这两者都将有助于将我们的经验发现转化为 一种以病人为中心的辅助决策工具的设计。该项目与国家癌症研究所的使命相关 因为它的重点是在肺癌筛查资格方面建立公平。我们的发现将产生持久的影响 关于精确健康和促进改进非洲肺癌早期发现的临床策略 美国人。

PROJECT SUMMARY/ABSTRACT Screening promotes early detection of cancer to decrease mortality. Unfortunately, significant racial disparities exist in lung cancer screening. Recently published findings by our team show that under current national screening guidelines African Americans have reduced eligibility for lung cancer screening compared to whites. These screening guidelines are based on a combination of age and smoking pack-year criteria derived from a national lung screening trial that was primarily (91%) white. Importantly, smoking behaviors and baseline risks for lung cancer differ greatly between African Americans and whites. Because of this, a risk-based screening strategy may provide a more equitable assessment of eligibility than current screening guidelines. However, the development of personalized risk prediction models for lung cancer in African Americans has been limited. To address this gap and to improve equity in screening eligibility, we propose building a personalized prediction tool using the combined data from three large-scale population-based prospective cohorts with substantial African American representation. The combined cohorts have over 336,000 individuals (44% African American) and 9,132 incident lung cancer cases from across the United States. We propose the following three aims: 1) construct a well-calibrated natural-history model of lung cancer risk for screening in African Americans, 2) evaluate lung cancer screening strategies by simulation and identify sub-populations who would benefit from screening, accounting for comorbidities and false-positives, and 3) develop a web-based decision aid for screening that is culturally appropriate. We will employ innovative machine learning techniques and state-of-the- art statistical methods to build a well-calibrated lung cancer prediction model for African Americans. Careful examination will identify sub-populations (such as women, low socioeconomic status, rural, age groups, etc.) that will benefit from screening. A key innovative aspect of this proposal is its community-engaged approach and partnership with a Community Advisory Board, both of which will help translate our empirical findings into the design of a patient-oriented decision aid. This project is relevant to the mission of the National Cancer Institute since it focuses on establishing equity in lung cancer screening eligibility. Our findings will have sustained impact on precision health and motivate improved clinical strategies for the early detection of lung cancer for African Americans.