Abstract
Lung cancer is the leading cause of cancer-related deaths in the United States. In 2013, the U.S Preventive Services Task Force (USPSTF) began recommending lung cancer screening for current and past smokers with at least 30 pack-years of smoking history. Evidence shows that with compliance, lung cancer screening may lower lung cancer-related deaths, but attendance may not be consistent across smokers from different races or geography. One way to determine if screening proved to be effective is by a shift towards earlier stages of diagnosis at the population level. In this study, we investigate if such a stage shift has occurred since the implementation of the USPSTF guidelines, and if disparities existed by race and/or geographical regions. Using data from the Surveillance, Epidemiology, and End Results (SEER) for lung cancers diagnosed 2009 to 2016. We compared yearly trends in local/regional vs distant stage at diagnosis before and after 2013, stratified by patient race (white vs black), and SEER geographical region. 320,116 lung cancers were diagnosed between 2009 and 2016. Among whites, the proportions diagnosed at stage 4 was 53.9% in 2009 to 48.4% post 2013 and 48.4% in 2016 and the proportion diagnosed at stage 1 was 22.1% in pre 2013 and 28.1% in post 2013.For blacks, the proportion diagnosed at stage 4 was 58.2% in 2009 and 54.7% post 2013 and the proportion diagnosed at stage 1 was 17.6% in pre 2013 and 21.9% in post 2013. Overall, a decrease in stage 4 lung cancer diagnosis was seen and an increase in stage 1 for both blacks and whites. (10.2% relative decrease for whites and 6.0% relative decrease for blacks). Results, however, varied by regions. Northeast regions had more later-stage decreasements among Whites (13.0% pre 2013 vs 7.2% post 2013) In the Southeast region, blacks and whites had smaller comparable reductions in proportions of stage 4 diagnosis (3.1% vs 3.0% overall). Lung cancer diagnosis has been decreasing over time, and stage shift is evident in some populations, however not uniformly by race and geographical regions. Blacks are still more likely to be diagnosed later-stage overall and by all regions in comparison to white pointing to problems with uptake of screening guidelines.
Citation Format: Paris Offor, Chelsea Obrochta, Ben Schumacher, Caroline Thompson. Trends in stage at diagnosis for lung cancer in the U.S., 2009-2016 [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-199.
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