Evaluating the impact of the 2021 USPSTF age expansion (50–54 years) on racial disparities in early-stage lung cancer diagnosis.

Abstract

10546 Background: In 2021, the USPSTF updated its guidelines to address known racial disparities in lung cancer outcomes. By lowering the screening age to 50 and reducing the pack-year threshold, one of the goals was to better identify Black individuals, who historically develop cancer at younger ages and with lower smoking intensity than their White counterparts. However, despite this expanded eligibility, screening uptake among the newly eligible 50–54 years cohort remains low. Our study evaluates whether these policy changes have translated into a tangible 'stage shift' toward earlier detection among the newly eligible age group and assesses if these benefits are being realized equitably across racial groups. Methods: We conducted a retrospective cohort study using SEER November 2024 sub data (21 Registries) for non-small cell lung cancer (NSCLC) cases. We compared the Pre-Guideline (2016–2019) period to the Post-Guideline (2022) period, excluding initial COVID-19 and transition years (2020–2021). A Difference-in-Differences (DiD) approach compared the newly eligible Target Group (50–54 years) against a Control Group (45–49 years) to control for secular staging trends. The primary outcome was the percentage of localized disease at diagnosis, stratified by race. Results: In the newly eligible 50–54 cohort, White patients demonstrated a robust stage shift, with localized disease increasing from 23.2% to 28.7% (p<0.001). Conversely, Black patients in the target age group experienced a decline in localized detection from 20.1% to 17.5%, with a concurrent rise in distant-stage diagnoses. Notably, Black patients in the younger control group (45–49) showed improved early detection (+3.3%), suggesting the disparity was specific to the guideline implementation in the target cohort. The DiD interaction was significant (p<0.05), confirming racially distinct outcomes. Hispanic patients saw a case volume surge without a significant rise in localized disease (22.3% to 22.6%). Conclusions: Initial data following the 2021 USPSTF expansion suggests an early stage shift for White patients aged 50–54, while a similar trend was not observed among Black patients in this first year of implementation. This divergence may reflect a temporary implementation lag, variability in provider adoption, or early access delays rather than a definitive failure of the policy. Continued longitudinal surveillance is required to determine whether this gap represents a transient uptake issue or a persistent disparity necessitating targeted structural interventions. Impact of age expansion on early detection (% localized disease). Group Race Pre-Guideline (2016-19) Post-Guideline (2022) Net Change Target (50-54 years) White 23.22% 28.65% +5.43% Black 20.14% 17.53% -2.61% Hispanic 22.33% 22.58% +0.25% Control (45-49 years) White 21.20% 22.44% +1.24% Black 17.79% 21.09% +3.30%