Alternative criteria could identify more patients who may benefit from lung cancer screening
Providing lung cancer screening to anyone who smoked any amount for at least 40 years or is between ages 60 to 80 years with at least 40 pack-years of smoking history would be simple and increase the equality of screening, according to the authors of a new study.
Researchers recently developed new criteria to identify patients who would benefit from lung cancer screening but are disproportionately excluded: those who smoked for a long time but not heavily, heavy smokers who quit more than 15 years ago, and certain patients from racial and ethnic minorities.
Data from the 1997-2014 National Health Interview Survey (NHIS) were used to develop alternative criteria using fast-and-frugal tree algorithms, while data from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System were used for comparison with U.S. Preventive Services Task Force (USPSTF) criteria. Life-years gained from screening were calculated by using a CT model. High benefit was defined as gaining an average of at least 16.2 days of life from three annual screenings. Findings were published Aug. 20 by Annals of Internal Medicine.
The researchers' alternative criteria for screening included people who smoked any amount each year for at least 40 years and anyone ages 60 to 80 years with at least 40 pack-years of smoking history. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; P<0.001) and specificity (86% vs. 84%; P<0.001) for identifying high-benefit people. The alternative criteria also provided greater sensitivity than the USPSTF criteria for racial and ethnic minorities (83% vs. 56% [P<0.001] for Black patients, 95% vs. 73% [P=0.086] for Hispanic patients, and 94% vs. 68% for Asian patients [P=0.171]) at similar specificity. The alternative criteria identified some high-risk, high-benefit groups excluded by the USPSTF criteria: those with a smoking duration of at least 40 years but less than 20 pack-years and a quit history of greater than 15 years, many of whom are members of racial and ethnic minorities.
The authors wrote that alternative criteria would produce more effective and equal screening, in addition to being easy to remember, and represent a feasible way to improve current eligibility criteria. This approach could also be useful for other cancer screening and prevention, they said. The fast-and-frugal algorithms would result in more effective screening, lead to better support of the ethical principle of “equal management for equal risk,” and substantially reduce racial disparities, the authors wrote.