Abstract IA08: Individualized risk based lung cancer screening: The way forward

Abstract

Abstract The United States Preventive Services Task Force (USPSTF) recommends annual low-dose computed tomography (CT) lung-cancer screening, as does the Center for Medicare and Medicaid Services (CMS) and many major medical organizations. The USPSTF criteria, similar to those used for entry into the definitive National Lung Screening Trial, are for persons aged 55-80 years, who currently smoke or quit within the past 15 years, and who have accumulated at least 30 pack-years of cigarette smoking. Risk calculators as compared to micro-simulation modeling as used for the USPSTF can more specifically account for demographic, clinical, and smoking characteristics and personalize risk. The USPSTF criteria may miss smokers at high risk for lung cancer who would have been selected for CT screening by individual risk calculators. Recently, the National Comprehensive Cancer Network guidelines for lung cancer screening added consideration of use of risk models to select ever-smokers for screening. Online risk tools are available to assist individuals and health care providers as to whether lung cancer screening may be helpful. Several lung cancer risk models are available, and comparisons across them have been done. In this presentation, a comparison we performed of the statistical predictive properties of 8 published risk models in 2 large prospective U.S. cohorts will be presented. Identifying a consensus cost-effective risk threshold to define screening eligibility is crucial. Another issue is how best to account for competing morbidities that might make screening less useful. Perhaps a life-years gained approach could help to adjust for this. Additionally, risk models require accurate risk factor data, which are rarely available in electronic health records and may require special collection. It also poses challenges in the health care delivery setting given its complexity. To better capture high-risk smokers and prevent premature deaths from lung cancer, eligibility for lung cancer screening should be based on exceeding a cost-effective risk threshold that balances CT screening benefits and harms, using a lung cancer risk tool validated in the U.S. population. Citation Format: Christine D. Berg. Individualized risk based lung cancer screening: The way forward [abstract]. In: Proceedings of the Fifth AACR-IASLC International Joint Conference: Lung Cancer Translational Science from the Bench to the Clinic; Jan 8-11, 2018; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(17_Suppl):Abstract nr IA08.