Risk model finds best candidates for lung cancer CT screening

A lung cancer risk-prediction model was found to be an effective tool for identifying individuals at risk for the disease and thus guiding the referral of patients who would benefit most from low-dose computed tomography (CT) screening.

The National Lung Screening Trial demonstrated a 20% decrease in lung cancer deaths among persons tested for the disease with low-dose CT compared with those screened by standard chest x-rays. The Liverpool Lung Project (LLP) risk model was created to identify people—both smokers and nonsmokers—who would most benefit from low-dose CT screening for lung cancer. The developers recently evaluated how well the model could stratify such patients.

According to a statement from the University of Liverpool, United Kingdom, where the LLP model was created, the model is used to calculate a person's chance of developing lung cancer within the next 5 years based on information regarding the person's duration of smoking, previous diagnosis of pneumonia, previous diagnosis of other cancer, occupational exposure to asbestos, and age of relatives at onset of lung cancer diagnosis. The model is also useful for selecting high-risk individuals for prevention and control programs. 

In the case-control and prospective cohort study, John K. Field, PhD, of the Roy Castle Lung Cancer Research Programme at The University of Liverpool Cancer Research Centre, and colleagues used data from three independent studies to determine 5-year absolute risks for lung cancer predicted by the LLP model. As the investigators reported in Annals of Internal Medicine (2012;157[4]:242-250), the analysis, which incorporated the harms and benefits of using a risk model to make clinical decisions, indicated that the LLP model showed good discrimination in terms of identifying persons who would benefit from lung cancer screening, and that the model performed better than smoking duration or family history alone in stratifying high-risk patients for lung cancer CT screening.

“The identification of individuals with a high risk of developing lung cancer who require appropriate investigations and subsequent treatment is the most important area of early lung cancer research today,” commented Field in the University of Liverpool statement. “The validation of the LLP risk model now provides the community with a powerful tool for the selection of future patients into such screening programs.”

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