Risk assessment for lung cancer screening can be improved by combining a blood biomarker test and a risk prediction model, according to research published in the Journal of Clinical Oncology.1

Researchers found this method improved risk assessment when compared with the 2021 US Preventive Services Task Force (USPSTF) screening criteria.2

The blood test measures a 4-marker protein panel (4MP) consisting of the precursor form of surfactant protein B, cancer antigen 125, carcinoembryonic antigen, and cytokeratin-19 fragment.

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The model was developed based on data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. PLCOm2012 is a validated model incorporating 11 predictors, including sociodemographic factors, medical history, and smoking exposure variables.3

For this study, the researchers evaluated the blood test and PLCOm2012 model using data and biospecimens from the PLCO Cancer Screening Trial. The team analyzed 1299 serum samples collected from 552 patients before lung cancer diagnosis and 8709 samples from 2193 individuals without lung cancer.

The 4MP alone yielded an area under the receiver operating characteristic curve (AUC) of 0.79 (95% CI, 0.77-0.82) for case sera collected within 1 year before diagnosis and 0.74 (95% CI, 0.72-0.76) for the entire specimen set.

When 4MP was combined with the PLCOm2012 model, the AUC was 0.85 (95% CI, 0.82-0.88) for case sera collected within 1 year before diagnosis.

When compared with USPSTF 2021 criteria, 4MP plus the PLCOm2012 model provided statistically significant improvements in sensitivity and specificity. The sensitivity was 88.4% with the combined method and 78.5% with the USPSTF criteria (9.9% difference). The specificity was 56.2% and 49.3%, respectively (6.9% difference). 

“These findings have important implications for improving lung cancer screening programs and reducing the burden of lung cancer through personalized risk assessment,” the researchers concluded.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


  1. Fahrmann JF, Marsh T, Irajizad E, et al. Blood-based biomarker panel for personalized lung cancer risk assessment. J Clin Oncol. Published online January 7, 2022. doi:10.1200/JCO.21.01460
  2. US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117
  3. Tammemagi MC, Katki HA, Hocking WG, et al. Selection criteria for lung-cancer screening. N Engl J Med. 2013; 368:728-736. doi:10.1056/NEJMoa1211776