Fewer Lung-Cancer Deaths, More Overdiagnosis With Risk-Based Screening Strategies

By Reuters Staff

December 31, 2019

NEW YORK (Reuters Health) - Risk-based strategies for lung-cancer screening prevent more deaths from the malignancy but lead to more overdiagnosis, than do current recommendations from the U.S. Preventive Services Task Force (USPSTF), according to a comparative modeling analysis.

The USPSTF currently recommends annual lung-cancer screening between the ages of 55 and 80 years for current and former smokers (who quit less than 15 years ago) who smoked 30 or more pack-years.

Several studies have suggested that individual risk assessment using established lung-cancer risk-prediction models might be better at identifying those most likely to benefit from screening.

Dr. Kevin ten Haaf of University Medical Center Rotterdam, in the Netherlands, and colleagues evaluated the long-term benefits and harms of three lung-cancer screening strategies (Bach, PLCOm2012, and Lung Cancer Death Risk Assessment Tool, or LCDRAT) compared with current USPSTF recommendations.

The Bach-based strategy required 40.2% more screens than the USPSTF criteria did, while averting 31.8% more deaths and yielding 22.6% more life-years, the researchers report in the Journal of the National Cancer Institute.

The PLCOm2012-based strategy required 6.0% fewer screens than the USPSTF criteria, but averted 10.8% more deaths and yielding similar number of life-years.

The LCDRAT strategy required 20.7% more screens than the USPSTF criteria, but it averted 24.9% more deaths and yielded 13.3% more life-years.

When risk-based strategies were modified to require similar CT screens as the USPSTF criteria did, they averted 13.1-13.9% more lung cancer deaths, gained 0.5-3.2% more life-years, and required 11.5-12.5% fewer screens per death averted, compared with USPSTF criteria.

Conversely, the absolute number of overdiagnosed cancers was 18.5-45.9% higher with risk-based strategies than with USPSTF criteria, and the average age at first screening eligibility was 5-10 years higher than with USPSTF criteria, and the risk thresholds for screening were higher.

"Future studies should investigate the cost-effectiveness of risk-based screening and the potential for reducing overdiagnosis in high-risk individuals," the authors conclude.

Dr. ten Haaf did not respond to a request for comments.

SOURCE: https://bit.ly/38iZwxr Journal of the National Cancer Institute, online November 29, 2019.