OA06.02 The Role of Simulation Modeling in Shaping Lung Cancer Screening Policies in the US and Elsewhere

Abstract

Models of the natural history of cancer have played an important role in shaping cancer prevention and control policies across the world. Notably, the US National Cancer institute (NCI) Cancer Intervention and Surveillance Modeling Network (CISNET) consortium has developed multiple such models and a modeling infrastructure that has supported the development of guidelines and policies for cancer screening and tobacco control in the US and elsewhere. The CISNET Lung models incorporate and synthetize smoking and lung cancer data from clinical trials, epidemiological studies and surveillance systems. These models have informed US screening guidelines. But important questions remain as screening programs are being implemented, such as the relative effectiveness of risk-based versus pack-year eligibility strategies or the potential of cessation programs within the context of lung screening. Simulation of the US 1950 and 1960 birth-cohorts show that for a given number of screens, risk-based screening programs lead in general to higher mortality reductions than pack-year based strategies. This is also true for LYG, but the difference is less pronounced. Independently of the program, adding cessation interventions at the point of screening leads to considerable gains in LYG, and to a lesser effect on deaths prevented. E.g., under current guidelines and a 40% screening uptake scenario, adding a cessation intervention at the time of first screen with a 15% success probability, could increase LYG by 140% and lung cancer deaths prevented by 28% (fig). But the actual gains would greatly depend on coverage and the cessation probability (fig). Simulation modeling provides a framework to extrapolate findings from clinical trials and epidemiological studies into population outcomes. This has shown to be key to be able to refine and identify lung cancer prevention optimal strategies for a given setting. And to gather support among stakeholders to adopt and implement such strategies.