More Lives Saved With Risk-Based Lung Cancer Screening

An alternative approach to lung cancer screening could better detect risk than current US Preventive Services Task Force (USPSTF) screening guidelines, suggests a new study published in JAMA.

Currently, the USPSTF recommends computed tomography (CT) lung cancer screening for “ever-smokers”—a person who has smoked at least 100 cigarettes in his or her lifetime—55 to 80 years of age who have smoked at least 30 pack-years with no more than 15 years since quitting. As an alternative to this approach, Anil K Chaturvedi, PhD (National Cancer Institute, Bethesda, MD), and colleagues explored the effectiveness of stratifying patients for screening based on their individualized lung cancer risks.

To calculate individual risks for lung cancer, the researchers created empirical risk models for lung cancer incidence and death based on data from participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) and the National Lung Cancer Screening Trial (NLST) who received annual CT lung cancer screening for 3 years beginning at the age of 50 years.

Using the model, risk-based selection screening of 9 million ever-smokers at the highest level of 5-year lung cancer risk was estimated to prevent 20% more deaths, and to reduce the estimated number needed to screen (NNS) to prevent 1 lung cancer death by 17%, compared with the USPSTF recommended approach to screening.

Relevant risk factors included age, race, sex, education, body mass index, family history of lung cancer, self-reported emphysema, pack-years of smoking, duration of smoking, years since smoking cessation, and packs smoked per day.

The authors concluded that screening individuals by their specific risk factors, rather than by the USPSTF criteria, could prevent more lung cancer deaths over 5 years and with greater efficiency.