Eligibility for lung cancer screening in Australia and the effect on screening eligibility of using spirometry to identify COPD

Abstract

Background: The proportion of people eligible for lung cancer screening in Australia is unknown. Risk prediction models used for screening eligibility, such as the PLCO m2012 , use self-reported Chronic Obstructive Pulmonary Disease (COPD) as a variable. Measured airflow obstruction has been advocated as part of eligibility assessment but this needs patient contact. The change in the proportion of people eligible if COPD is self-reported, defined by symptoms or airflow obstruction is unknown. Aim: To estimate the proportion of people eligible for lung cancer screening in Australia and to measure the effect of spirometry to identify COPD on the proportion eligible. Methods: Cross-sectional study of 2523 people aged 55-68 years who live in the Busselton Shire of Western Australia. Eligibility was based on United States Preventative Services Task Force (USPSTF) criteria or PLCO m2012 lung cancer risk >1.5%. Results: Using USPSTF criteria, 20.1%, (95%CI 17.9-22.3) of ever-smokers would be eligible for screening. Using PLCO m2012 criteria, fewer ever-smokers would be eligible (17.9%, 95%CI 15.8-20.0, p m2012 risk (p=0.06). Conclusions: The proportion of ever-smokers eligible for lung cancer screening in this population is 17.9-20.1%. Up to 450,000 people in Australia may benefit from lung cancer screening. Using symptoms to identify COPD is an appropriate surrogate for spirometry when determining presence of COPD in this population.