Li C. Cheung, PhD; Christine D. Berg, MD; Philip E. Castle, PhD; Hormuzd A. Katki, PhD *; Anil K. Chaturvedi, PhD *
Note: Dr. Cheung had full access to all of the data in the study and final responsibility for the decision to submit the manuscript for publication.
Financial Support: By the Intramural Research Program of the National Cancer Institute, National Institutes of Health.
Disclosures: Dr. Cheung reports that he previously coauthored a manuscript proposing the Lung Cancer Death Risk Assessment Tool model. Dr. Berg reports consultancies for GRAIL and Medial EarlySign and reports that she is the chair of the Policy Task Group of the American Cancer Society National Lung Cancer Roundtable. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1263.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement: Study protocol: Not available. Statistical code and data set: Available from Dr. Cheung (e-mail, li.cheung@nih.gov).
Corresponding Author: Li C. Cheung, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Room 7E612, Bethesda, MD 20892; e-mail, li.cheung@nih.gov.
Current Author Addresses: Drs. Cheung, Berg, Katki, and Chaturvedi: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD 20892.
Dr. Castle: Albert Einstein School of Medicine, 1300 Morris Park Avenue, Belfer 1308C, Bronx, NY 10461.
Author Contributions: Conception and design: L.C. Cheung, C.D. Berg, P.E. Castle, H.A. Katki, A.K. Chaturvedi.
Analysis and interpretation of the data: L.C. Cheung, C.D. Berg, P.E. Castle, H.A. Katki, A.K. Chaturvedi.
Drafting of the article: L.C. Cheung, P.E. Castle, H.A. Katki, A.K. Chaturvedi.
Critical revision of the article for important intellectual content: L.C. Cheung, C.D. Berg, P.E. Castle, H.A. Katki, A.K. Chaturvedi.
Final approval of the article: L.C. Cheung, C.D. Berg, P.E. Castle, H.A. Katki, A.K. Chaturvedi.
Provision of study materials or patients: C.D. Berg, H.A. Katki.
Statistical expertise: L.C. Cheung, H.A. Katki.
Obtaining of funding: H.A. Katki.
Administrative, technical, or logistic support: H.A. Katki.
Collection and assembly of data: C.D. Berg, H.A. Katki.
Although risk-based selection of ever-smokers for screening could prevent more lung cancer deaths than screening according to the U.S. Preventive Services Task Force (USPSTF) guidelines, it preferentially selects older ever-smokers with shorter life expectancies due to comorbidities.
To compare selection of ever-smokers for screening based on gains in life expectancy versus lung cancer risk.
Cohort analyses and model-based projections.
U.S. population of ever-smokers aged 40 to 84 years.
130 964 National Health Interview Survey participants, representing about 60 million U.S. ever-smokers during 1997 to 2015.
Annual computed tomography (CT) screening for 3 years versus no screening.
Estimated number of lung cancer deaths averted and life-years gained after development of a mortality model.
Using the calibrated and validated mortality model in U.S. ever-smokers aged 40 to 84 years and selecting 8.3 million ever-smokers to match the number selected by the USPSTF criteria in 2013 to 2015, the analysis estimated that life-gained–based selection would increase the total life expectancy from CT screening (633 400 vs. 607 800 years) but prevent fewer lung cancer deaths (52 600 vs. 55 000) compared with risk-based selection. The 1.56 million persons selected by the life-gained–based strategy but not the risk-based strategy were younger (mean age, 59 vs. 75 years) and had fewer comorbidities (mean, 0.75 vs. 3.7).
Estimates are model-based and assume implementation of lung cancer screening with short-term effectiveness similar to that from trials.
Life-gained–based selection could maximize the benefits of lung cancer screening in the U.S. population by including ever-smokers who have both high lung cancer risk and long life expectancy.
Intramural Research Program of the National Cancer Institute, National Institutes of Health.
Cheung LC, Berg CD, Castle PE, et al. Life-Gained–Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening. Ann Intern Med. 2019;171:623–632. [Epub ahead of print 22 October 2019]. doi: https://doi.org/10.7326/M19-1263
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© 2020
Published: Ann Intern Med. 2019;171(9):623-632.
DOI: 10.7326/M19-1263
Published at www.annals.org on 22 October 2019
Cancer Screening/Prevention, Cardiology, Coronary Risk Factors, Hematology/Oncology, Lung Cancer.
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