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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

1
Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands.
2
Department of Radiology, Stanford University, Palo Alto, California, United States of America.
3
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States of America.
4
Department of Medicine, Stanford University, Palo Alto, California, United States of America.
5
Harvard Medical School, Boston, Massachusetts, United States of America.
6
Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
7
Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
8
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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%.

CONCLUSIONS:

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.

PMID:
31566216
DOI:
10.1093/jnci/djz164

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