Lung cancer screening: higher thresholds could prevent more deaths

  • Landy R & al.
  • Ann Intern Med
  • 04.06.2019

  • von Yael Waknine
  • Clinical Essentials
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Takeaway

  • New risk thresholds for lung cancer screening could prevent more deaths than current United States Preventive Services Task Force (USPSTF) guidelines.

Why this matters

  • The USPSTF is considering recommending externally validated screening models for ever-smokers.
  • Risk thresholds should be adjusted with changing demographic habits.

Study design

  • Comparison of risk thresholds based on 2005 and 2015 National Health Interview Survey for ever-smokers aged 50-80 years:
    • USPSTF: age 55-80 years with ≥30 pack-year history, ≤15 years since quitting.
    • National Comprehensive Cancer Network (NCCN): ≥1.3% 6-year risk based on the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 (PLCOM2012: ≥1.3%-NCCN).
    • ≥1.51% 5-year risk (≥1.51%-PLCOM2012).
    • ≥1.2% 5-year risk based on Lung Cancer Death Risk Assessment Tool (≥1.2%-LCDRAT).

Key results

  • In 2015, USPSTF guidelines identified 8.0 million screening-eligible individuals.
    • ≥1.3%-NCCN: +4.6 million (57% increase).
    • ≥1.51%-PLCOM2012: +3.3 million (41% increase).
    • ≥1.2%-LCDRAT: +1 million (12% increase).
  • Screening efficacy: number needed to screen (NNS) to prevent 1 death, false-positive results per prevented death (FPPD):
    • USPSTF: 194, 133.
    • ≥1.3%-NCCN: 222, 150.
    • ≥1.51%-PLCOM2012: 207, 141.
    • ≥1.2%-LCDRAT: NNS, 168, 119.
  • Projected thresholds required to screen 8.0 million as in 2015:
    • ≥2.19% 6-year PLCO lung cancer risk: NNS, 169; FPPD, 119.
    • ≥1.33% 5-year LCDRAT lung cancer death risk: NNS, 156; FPPD, 112.

Limitations

  • Estimated data.