Analysis of the 30-Pack-Year Smoking Threshold in African Americans From an Underserved Lung Cancer Screening Program

Anupam Basu*, Luke Kopulos, Nicole Geissen, Shashvat Sukhal, Sean B. Smith

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Purpose: African Americans were underrepresented in lung cancer screening (LCS) trials, despite having higher lung cancer incidence and worse outcomes compared with Caucasians. There is concern that the 30-pack-year threshold excludes some African Americans who may benefit from LCS. Methods: LCS in an underserved health care system was reviewed. Providers attested that patients met LCS criteria, including 30-pack-year history, but patients also self-reported smoking histories. Self-reported data were used to identify patients with <30-pack-year histories. Results: Over 2 years, 784 patients self-reported sufficient data to calculate pack-years. The majority were men (57.5%), and 66.2% were African Americans. Median total years smoked was 40 (interquartile range, 30-45 years), and median pack-years was 25 (interquartile range, 15-40 pack-years). African Americans were more likely to report <30 pack-years compared with other races (P < .001). The overall incidence of lung cancer was 2.0%, and incidence was similar for those with ≥30 or <30 pack-years (2.1% versus 2.0%; odds ratio, 0.94; 95% confidence interval, 0.35-2.53; P =. 902). Race was not associated with lung cancer diagnosis, but African Americans were the only race to have lung cancer if pack-years were <30. The incidence of cancer in African Americans was similar in those who reported ≥30 or <30 pack-years (2.2% versus 2.7%; odds ratio, 1.21; 95% confidence interval, 0.39-3.75; P =. 740), and the 30-pack-year threshold was not associated with lung cancer diagnosis. Conclusions: This is the first review of LCS in African Americans who self-reported <30 pack-years. Although retrospective, these data raise concern that the 30-pack-year threshold may not be an appropriate LCS criterion in African Americans.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalJournal of the American College of Radiology
Issue number1
StatePublished - Jan 2021


  • 30-pack-year smoking
  • African American
  • Lung cancer screening
  • underserved

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Analysis of the 30-Pack-Year Smoking Threshold in African Americans From an Underserved Lung Cancer Screening Program'. Together they form a unique fingerprint.

Cite this