Alternative Model for Lung Cancer Screening Shows Higher Sensitivity Than Current Model

A new study published in Cancer found an alternative model to identify patients with lung cancer who are eligible for screening was more accurate than the current method based on United States Preventive Services Task Force (USPSTF) criteria. The USPSTF determines eligibility for lung cancer screening based on age and smoking history. Specifically, individuals who are 50 to 80 years of age or used to smoke and quit 15 years ago or less with 20 pack years of smoking history (eg, 1 pack a day for 20 years, 2 packs a day for 10 years) are eligible for lung cancer screening.¹

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PLCOm2012 is a more personalized lung cancer risk-prediction model based on the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial that uses additional parameters including personal history of cancer, family history of lung cancer, personal history of chronic obstructive pulmonary disease, education level, body mass index, and race to predict an individual’s risk of cancer. A version of the model that does not include race as a parameter is called PLCOm2012noRace.¹

“Determining screening eligibility using risk prediction models that consider more individualized lung cancer risk factors has been shown in several studies, including this one, to do a better job in selecting people for screening as compared with USPSTF age and smoking history criteria,” lead study author Martin C. Tammemägi, PhD, of Brock University said in a press release. “This research along with similar studies in other underserved populations should be used to encourage policy makers to include the use of more individualized screening eligibility criteria using risk prediction models.”¹

To compare the USPSTF with the PLCOm2012 and PLCOm2012noRace methods, the study authors applied them to a total 1545 enrolled participants with lung cancer. The PLCOm2012 models had demonstrated higher sensitivity and identified more people with lung cancer eligible for screening compared to the USPSTF 2013 and USPSTF 2021 criteria. The sensitivity of USPSTF2021 criteria was 66.1%, and with and without race, the PLCOm2012 models’ sensitivity were 90.7% and 89.6%, respectively (both p < .001).^1,2

Further, 1.4% of individuals were younger than 50 years of age, and proportions did not differ by Indigenous classification (Indigenous: 2.0%; non-Indigenous: 1.3%; p = .518). The authors indicate that it is not necessary to screen those younger than 50 years of age for lung cancer due to the low percentage of individuals who were diagnosed.^1,2

“Although race is a social construct, until the risk factors for this construct are identified and included in risk prediction models, jurisdictions with large populations of underserved ‘races’ who are found to be at excess risk—including many Indigenous populations—should consider using risk prediction models incorporating race as a predictor variable,” said Tammemägi in the press release.¹

Reference

1. Wiley. Should a more individualized model replace the current method for determining which people should be screened for lung cancer? News release. October 9, 2023. Accessed October 10, 2023. https://www.eurekalert.org/news-releases/1003457

2. Tammemägi, MC, Cina, K, Kitts, AKB, et al. Sensitivity of US Preventive Services Task Force and PLCOm2012 lung cancer screening eligibility criteria in individuals with lung cancer in South Dakota self-reporting as Indigenous and non-Indigenous. Cancer. 2023; 1-11. doi:10.1002/cncr.34947