Robert P. Young, MD; Raewyn J. Hopkins, MD; David E. Midthun, MD
Potential Conflicts of Interest: Dr. Young: Consultancy and patents (planned, pending, or issued): Synergenz BioSciences Ltd. Dr. Midthun: Royalties: UpToDate; Payment for development of educational presentations: American Physician Institute, MKSAP 16, ACP PIER series, Clinical Care Options inPractice; Other: Integrated Diagnostics.
Young R., Hopkins R., Midthun D.; Predictive Accuracy of the Liverpool Lung Project Risk Model. Ann Intern Med. 2013;158:568. doi: 10.7326/0003-4819-158-7-201304020-00014
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Published: Ann Intern Med. 2013;158(7):568.
TO THE EDITOR:
We agree with Raji and colleagues (1) that the selection of current and former smokers for computed tomography (CT) screening for lung cancer should target those at greatest risk “to maximize the benefit–harm ratio” (2). We also agree that a multivariate approach to risk assessment is the best way to achieve this goal (3) but question whether the validated Liverpool Lung Project (LLP) model maximizes this ratio as suggested.
Although the LLP multivariate model performs better than risk models for lung cancer that use age and smoking history alone (1), it is less clear that this superior performance translates into improved CT screening outcomes. Bach and Gould (4) strongly argued that screening should be limited to persons at greatest risk to avert the greatest number of deaths from lung cancer per person screened. Using the results of the NLST (National Lung Screening Trial), they showed that the absolute number of deaths averted by screening is maximized when the detection rate (or death rate) for lung cancer is maximized.
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