Send to

Choose Destination
J Natl Cancer Inst. 2019 Sep 30. pii: djz164. doi: 10.1093/jnci/djz164. [Epub ahead of print]

A comparative modeling analysis of risk-based lung cancer screening strategies.

Author information

Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Department of Radiology, Stanford University, Palo Alto, California, United States of America.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America.
Department of Medicine, Stanford University, Palo Alto, California, United States of America.
Harvard Medical School, Boston, Massachusetts, United States of America.
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America.



Risk-prediction models have been proposed to select individuals for lung cancer screening. However, their long-term effects are uncertain. This study evaluates long-term benefits and harms of risk-based screening compared to current United States Preventive Services Task Force (USPSTF) recommendations.


Four independent natural-history models performed a comparative modeling study evaluating long-term benefits and harms of selecting individuals for lung cancer screening through risk-prediction models. 363 risk-based screening strategies varying by screening starting and stopping age, risk-prediction model used for eligibility (Bach, PLCOm2012, LCDRAT), and risk-threshold were evaluated for a 1950 U.S. birth-cohort. Among the evaluated outcomes were percentage of individuals ever screened, screens required, lung cancer deaths averted, life-years gained and overdiagnosis.


Risk-based screening strategies requiring similar screens among individuals aged 55-80 as the USPSTF-criteria (corresponding risk-thresholds: Bach: 2.8%, PLCOm2012: 1.7%, LCDRAT: 1.7%) averted considerably more lung cancer deaths (Bach: 693, PLCOm2012: 698, LCDRAT: 696, USPSTF: 613). However, life-years gained were only modestly higher (Bach: 8,660, PLCOm2012: 8,862, LCDRAT, 8,631,USPSTF: 8,590) and risk-based strategies had more overdiagnosis (Bach: 149, PLCOm2012: 147, LCDRAT: 150, USPSTF: 115). Sensitivity analyses suggests excluding individuals with limited life-expectancies (<5 years) from screening retains the life-years gained by risk-based screening, while reducing overdiagnosis by > 65.3%.


Risk-based lung cancer screening strategies prevent considerably more lung cancer deaths than current recommendations. However, they yield modest additional life-years and increased overdiagnosis due to predominantly selecting older individuals. Efficient implementation of risk-based lung cancer screening requires careful consideration of life-expectancy for determining optimal individual stopping ages.


Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center