Racial Disparities in Smoking Behaviors May Lead to Discrepancies in Lung Cancer Screening


    A new study out of Yale says that racial disparities in smoking behaviors can lead to discrepancies in lung cancer screening. Additionally, researchers found that some black smokers who are at risk for lung cancer may be ineligible for screening based on biased criteria.

    “Racial differences in smoking initiation, cessation, and intensity give rise to substantial differences in risk for tobacco-related diseases,” said Theodore Holford, who is the senior author of the study, a professor of public health, and a member of Yale Cancer Center’s Cancer Prevention and Control Program. Holford said the study also “shows that commonly used measures may give rise to disparities in access to lifesaving interventions.”

    The criteria used by the Centers for Medicare and Medicaid Services for determining whether or not to cover screenings deems eligible only people over age 55 who have a history of at least 30 “pack years”. A “pack year” is calculated by multiplying the number of years smoking by the number of packs smoked per day.

    Holford’s study, based on data from the National Health Interview Surveys from 1965 to 2012, shows that black smokers generally have fewer “pack years” because data indicates that they smoke fewer individual cigarettes per day. They also start smoking at an older age, compared to white smokers who are more likely to start smoking in their late teens.

    However, black smokers have been found to continue to smoke later in life, while white smokers are more likely to quit. This leads to black smokers actually smoking for a larger portion of their lives overall.

    Because “pack years” are calculated before the years add up, this often leaves them ineligible for screenings. Their risk for tobacco-related illnesses and death is just as high, if not higher, than that of white smokers.

    Research has shown that those who smoke are far more likely to develop lung cancer, heart disease, and stroke than non-smokers. Research also shows that smoking doubles the risk of age-related macular degeneration, which may lead to blindness.

    Holford’s study, and many of those before it, prove that leaving these individuals out of the screening process is detrimental to public health.

    “We need to think about how to better develop criteria to determine eligibility,” Holford concluded.