Risk-based lung cancer screening eligibility criteria: towards implementation.

Abstract

Retrospective studies have consistently shown that risk-prediction models are superior at identifying individuals eligible for lung cancer screening compared with criteria based on combinations of age accumulated pack-years and years since smoking cessation (ie, pack-year criteria). 1 ten Haaf K Jeon J Tammemägi MC et al. Risk prediction models for selection of lung cancer screening candidates: a retrospective validation study. PLOS Med. 2017; 14e1002277 Crossref Scopus (149) Google Scholar Although some studies advocate the use of risk-prediction models in existing and future screening programmes, others have been reserved in advocating their use because of the absence of evidence from prospective studies. 2 Force USPSTScreening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021; 325: 962-970 Crossref PubMed Scopus (228) Google Scholar , 3 Tammemägi MC Darling GE Schmidt H et al. Selection of individuals for lung cancer screening based on risk prediction model performance and economic factors—the Ontario experience. Lung Cancer. 2021; 156: 31-40 Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar In The Lancet Oncology, Martin Tammemägi and colleagues 4 Tammemägi MC Ruparel M Tremblay A et al. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study. Lancet Oncol. 2021; (published online Dec 10.)https://doi.org/10.1016/S1470-2045(21)00590-8 Summary Full Text Full Text PDF PubMed Google Scholar report an interim analysis of the International Lung Screening Trial (ILST), a large prospective multinational trial that compares a risk-prediction model with pack-year criteria. The ILST compared the sensitivity of the US Preventive Services Task Force (USPSTF) 2013 eligibility criteria (aged 55–80 years, ≥30 pack-years smoking history, and ≤15 years since smoking cessation) with the PLCOm2012 risk model when selecting a similar number of eligible individuals (aged 55–80 years with a PLCOm2012 risk threshold ≥1·7%). The sensitivity of the PLCOm2012 model to identify individuals who develop lung cancer was 15·8 percentage points higher than that of the USPSTF2013 criteria (162 [94·7%; 95% CI 90·2–97·6] of 171 individuals vs 135 [78·9%; 72·1–84·8] of 171 individuals; p=0·0001). Analyses that included individuals not meeting either the PLCOm2012 risk threshold of at least 1·7% or USPSTF2013-positive criteria also showed superior sensitivity (162 [85·3%; 79·4–90·0] of 190 individuals vs 135 [71·1%; 64·0–77·4] of 190 individuals; p=0·0001) and both criteria had similar specificities (8357 [65·6%; 64·7–66·4] of 12 735 vs 8330 [65·4%; 64·5–66·2] of 12 735 individuals; p=0·72). Thus, the ILST demonstrated that the superiority of risk-prediction models over pack-year criteria is maintained in a prospective analysis. USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort studyPLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. Full-Text PDF Open Access