Lung Cancer Screening: Risk-Targeting Approach vs NLST Eligibility Criteria

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Using risk models may further complicate the screening process, experts have cautioned.
Using risk models may further complicate the screening process, experts have cautioned.

A risk-targeting approach may help improve lung cancer screening efficiency in terms of early lung cancer deaths prevented per person screened. However, the gains in efficiency appear to be attenuated and modest in terms of life-years, quality-adjusted life-years (QALYs), and cost-effectiveness, according to a new analysis published in the Annals of Internal Medicine.

“Using the current guidelines, approximately 9 million Americans are eligible for lung cancer screening. As all oncology nurses will know, the decision to screen is complicated and the question remains: How do we decide whom to screen?” said first author Vaibhav Kumar, MD, a postdoctoral fellow at Tufts Medical Center in Boston.

 

One option, according to Dr Kumar, is to use age and smoking exposure as the current guidelines recommend. Another option is a risk-targeting approach, which combines individual characteristics such as age, sex, smoking exposure, and medical history in a statistical model to calculate a patient's specific risk of dying from lung cancer.

THE STUDY

Dr Kumar and colleagues examined the value of risk-targeting selection compared with National Lung Screening Trial (NLST) eligibility criteria for lung cancer screening with low-dose computed tomography (LDCT). The study reviewed incremental 7-year mortality, life expectancy, QALYs, and costs in current and former smokers. They also reviewed overall cost-effectiveness of screening with LDCT vs chest radiography at each decile of lung cancer mortality risk.

Proper screening requires identifying high-risk persons and advising them on the harms and benefits of screening. Some experts have raised concerns that using risk models may further complicate the process and be a barrier to screening. 

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