Aldrich MC, et al. – Via performing a study involving 48,364 adult smokers who were observed for up to 12 years, experts assessed the diagnostic accuracy of USPSTF lung cancer screening eligibility criteria in a predominantly African American and low-income cohort. In all, 32,463 participants were African American and 5,901 were white, with 1,269 who had diagnosed incident lung cancers. In comparison with white smokers, a markedly lesser percentage of African American smokers were suitable for screening. A weaker percentage of suitable lung cancer cases in African American smokers was related to lesser smoking pack-years among African American vs white smokers. Between African American and white smokers for all ages, racial differences were identified in the sensitivity and specificity of USPSTF guidelines. Also, reduction in the smoking pack-year eligibility criteria to a minimum 20-pack-year history was correlated with an elevated percentage of screening eligibility of African American smokers and with a fair performance of sensitivity and specificity as that with white smokers across all ages. Hence, recent USPSTF lung cancer screening guidelines were observed as too conservative for African American smokers. Furthermore, for African American smokers at high risk for lung cancer, race-specific adjustment of pack-year criteria in lung cancer screening guidelines might lead to more impartial screening.