Risk-based Model for CT Lung Cancer Screening Could Prevent More Cancer Deaths

A risk-based model for computer tomography (CT) lung cancer screening was estimated to prevent a greater number of lung cancer deaths over 5 years compared with a model based on US Preventive Services Task Force (USPSTF) recommendations, a study published in JAMA has shown.¹

Based on findings from the National Lung Cancer Screening Trial, the USPSTF recommends annual CT lung cancer screening for ever-smokers aged 55 to 80 years who have smoked at least 30 pack-years with no more than 15 years since quitting; however, researchers at the National Cancer Institute in Bethesda, MD, hypothesized that using individualized lung cancer risk calculation to select ever-smokers for screening may be more effective and efficient.

For this study, researchers analyzed data on ever-smokers from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) control group to develop empirical risk models for lung cancer incidence and death in the absence of CT screening. They then validated the model in the chest radiography groups of the PLCO and National Lung Cancer Screening Trial, and further validated the death model in the National Health Interview Survey.

Afterwards, investigators applied the models to US ever-smokers aged 50 to 80 years who participated in the National Health Interview Survey approximately a decade later to estimate outcomes of this risk-based model.

Results showed that a model based on USPSTF guidelines would prevent an estimated 46 488 (95% CI, 43 924-49 053) lung cancer deaths over 5 years. In contrast, the risk-based model was estimated to prevent 20% more deaths the USPSTF recommendation-based model (55 717 [95% CI, 53 033-58 400]).

The study further demonstrated that the model based on USPSTF recommendations would need to screen 194 (95% CI, 187-201) individuals to prevent 1 lung cancer death compared with 162 [95% CI, 157-166]) individuals for the risk-based model, a reduction of 17%.

Reference

1. Katki HA, Kovalchik SA, Berg CD, et al. Development and validation of risk models to select ever-smokers for CT lung cancer screening [published online ahead of print May 15, 2016]. JAMA. doi: 10.1001/jama.2016.6255.