Lung cancer risk model better predictor than smoking or family history
The Liverpool Lung Project risk model was a better predictor than smoking history or family history for determining whether to send a patient for computed tomography lung cancer screening, a study found.
The Liverpool Lung Project risk model was a better predictor than smoking history or family history for determining whether to send a patient for computed tomography (CT) lung cancer screening, a study found.
To evaluate the discrimination of the risk model and demonstrate its predicted benefit, researchers used data from three case-control and prospective cohort studies: the European Early Lung Cancer (EUELC) and Harvard case-control studies and the Liverpool Lung Project population-based prospective cohort (LLPC) study.
Results appeared in the Aug. 21 Annals of Internal Medicine.
The Liverpool Lung Project risk model had higher discriminative ability across the three data sets than smoking duration or family history of lung cancer, researchers reported. The Liverpool Lung Project model had modest discrimination in the EUELC data set (area under the curve [AUC], 0.67; 95% CI, 0.64 to 0.69) and good discrimination in both the Harvard (AUC, 0.76; 95% CI, 0.75 to 0.78) and LLPC (AUC, 0.82; 95% CI, 0.80 to 0.85) data sets.
The AUC for smoking duration, the strongest of the individual risk factors, was 0.63, 0.74, and 0.72 in the EUELC, Harvard, and LLPC data sets, respectively. The Liverpool Lung Project risk model had moderate overall calibration and improved accuracy at higher values of predicted risks, the authors noted.
At a threshold of 5% absolute risk, the model achieved a higher proportion of true-positive classifications than a screen-all strategy (2.3% higher for the LLPC data and 3% higher for the EUELC data) with the same proportion of false-positive classifications. The Liverpool Lung Project risk model provided greater net benefit than all alternative strategies at thresholds of absolute risk ranging from 3% to 15%.
Researchers wrote, “Identifying a single average risk threshold for a population is often difficult because of a lack of data on harms, benefits, and actual outcomes in a screened population. Unlike cardiovascular disease, for which a 10-year risk of 20% has been recommended to stratify patients as high-risk, no consensus is available in cancer screening.”
Retrospective analysis of data from screening studies in Europe and the U.K. may help to standardize the risk threshold at which to recommend population-based CT screening, the authors concluded.