Alternative lung cancer screening criteria may increase sensitivity versus current guidelines

1. In this modeling study, an alternative set of lung cancer screening criteria was more sensitive and specific overall in identifying high-benefit people as compared to the current United States Preventive Services Task Force criteria.

2. The alternative criteria were also more sensitive in identifying high-benefit people among racial and ethnic minorities.

Evidence Rating Level: 2 (Good)

Study Rundown: Lung cancer is the leading cause of cancer-related mortality in the United States, with the most significant risk factor being smoking. The current guidelines from the United States Preventive Services Task force (USPSTF) recommend lung cancer screening for individuals who are between 50 and 80 years of age, have a smoking history of at least 20 pack-years, and are current smokers or have quit within the last 15 years. However, recent studies suggest that the criteria endorsed by the USPSTF may exclude a significant number of individuals who would benefit from screening, including those from marginalized races or ethnic groups. Multivariable prediction models which account for the total life expectancy gained from screening may help to reduce this issue, but clinical implementation of such prediction models remains a challenge. Hence, this study developed alternative simple lung cancer screening criteria and compared their performance against the current USPSTF criteria in identifying high-benefit people in the United States between the ages of 40 and 80 years with any amount of smoking history. The final alternative criteria included individuals who had either smoked any amount yearly for at least 40 years or people between the ages of 60 and 80 years with at least a 40-pack-year smoking history. Overall, the alternative criteria were more sensitive and specific in identifying high-benefit people compared to the USPSTF criteria. Moreover, the alternative criteria were more sensitive in identifying high-benefit people among racial and ethnic minorities, including Black, Hispanic, and Asian individuals. The study results were limited by the nature of its design, which utilized model-based projections.

Click to read the study in AIM

Relevant Reading: Screening for lung cancer U.S. Preventive Services Task Force recommendation statement

In-Depth [retrospective cohort]: This study used model-based projections to derive alternative simple criteria for lung cancer screening and compared them with the current USPSTF criteria in their ability to identify high-benefit individuals in the United States. All individuals from 40 to 80 years of age with a history of smoking based on the annual National Health Interview Survey (NHIS) from 1997 to 2018 were included. Using the life-years gained from screening computed tomography (LYFS-CT) model, “high-benefit” individuals were defined as those who would gain at least 16.2 days of life from 3 annual screens as recommended by the American College of Chest Physicians (CHEST). The final alternative criteria, which were derived using “fast-and-frugal trees,” included individuals who had either smoked any amount yearly for at least 40 years or those between the ages of 60 and 80 years with at least 40-pack-years of smoking. The LYFS-CT model was adjusted to enhance eligibility for individuals from disadvantaged racial or ethnic groups when their race had shorter life expectancy than White individuals. Overall, the alternative criteria and the USPSTF criteria chose a nearly identical population size for screening (14.1 million people), but the alternative criteria exhibited increased sensitivity (91% vs 78%; P<0.001) and increased specificity (86% vs 84%; P<0.001) for identifying high-benefit individuals. The alternative criteria also exhibited increased sensitivity in identifying high-benefit people among racial and ethnic minorities as compared to the USPSTF criteria (Black: 83% vs 56% [P<0.001]; Hispanic: 95% vs 73% [P=0.086]; Asian: 94% vs 68% [P=0.171]), as well as those who had smoked at lower doses for longer durations (less than 20 pack-years over at least 40 years) and had longer quit histories (greater than 15 years). In summary, this study demonstrated that alternative simple lung cancer screening criteria may be more sensitive in identifying high-benefit people compared to the guidelines published by the USPSTF.

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