Risk-based computed tomography screening for lung cancer may be superior to current screening guidelines

1. This study predicted that a risk-based, computed tomography (CT) screening program for lung cancer in individuals between 50 and 80 years of age would prevent more deaths than current United States Preventative Services Task Force (USPSTF) guidelines.

2. This risk-based screening methodology would yield a lower number needed to screen than current USPSTF guidelines.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Recent research has shown that screening with low-dose CT scans can decrease lung cancer deaths among all individuals with a history of tobacco use. Less is known, however, about the impact of CT screening based on individualized risk factors. This study utilized three cohort studies to explore the effects of conducting CT screening for lung cancer in a risk based fashion. Based on the current USPSTF guidelines, roughly 9 million people between the ages of 50 and 80 should be screened for lung cancer, which is estimated to prevent 46,488 deaths over the next 5 years. However, the results of this study concluded that screening individuals between the ages of 50 and 80 at the highest individualized risk of developing lung cancer could prevent a larger number of deaths, 55,717, over the next 5 years.

The risk-based model utilizes a specific patient’s demographics and social history to calculate their expected 5-year risk of developing lung cancer, and recommends CT screening only for those at the highest risk. Based on this study’s modeling, screening an equal number of patients based on their individualized risk would be superior to the current USPSTF guidelines. While this study is strengthened by its large sample sizes and detailed individual data, it is limited by the use of models to estimate outcomes. Therefore, a randomized controlled trial applying this risk-based methodology against the current USPSTF guidelines is needed to determine the actual outcomes.

Click to read the study, published today in JAMA

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

In-Depth [prospective cohort]: This study utilized data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, the National Lung Screening Trial (NLST), and the National Health Interview Survey (NHIS) to compare lung cancer risk-based CT screening to current USPTF screening guidelines. Current guidelines recommend annual low-dose CT scans for the identification of lung cancer in patients between the age of 55 and 80 who are current smokers or who quit within the last 15 years with at least 30 pack years of smoking history. The risk-based model, on the other hand, identifies patients at the highest estimated 5-year risk of developing lung cancer based on their specific demographic and social factors.  Results showed that screening nine million individuals between 50 and 80 years of age with CT scans for lung cancer using USPTF guidelines would prevent 46,488 (95% CI 43,924-49,053) lung cancer deaths over five years. The risk-based model was estimated to prevent 55,717 (95% CI 53,033-58,400) lung cancer deaths over five years, an 11% absolute increase (p<0.001).  Moreover, the number needed to screen was lower in the risk based model than in the USPTF model (p<0.001).

Image: PD

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