Table.
Projected Performance of Proposed Risk Thresholds for Selection of Ever-Smokers for CT Lung Cancer Screening Using NHIS 2015 Data*
| Criteria | Risk Calculator | U.S. Ever-Smokers Aged 50-80 y |
Screening Efficiency |
Screening Harms |
Screening Effectiveness† |
||||
|---|---|---|---|---|---|---|---|---|---|
| Ever-Smokers Selected (Millions), n (%) | Increase vs. USPSTF Guidelines (95% CI‡), % | NNS to Prevent 1 Death | Improvement vs. USPSTF Guidelines (95% CI‡), % | False-Positive Results per Prevented Death, n | Improvement vs. USPSTF Guidelines (95% CI‡), % | Lung Cancer Deaths Prevented, n | Increase vs. USPSTF Guidelines (95% CI‡), % | ||
| USPSTF guidelines§ | NA | 8.0 (18.1) | NA | 194 | NA | 133 | NA | 41 298 | NA |
| NCCN guidelines (1.3% 6-y lung cancer risk)‖ | PLCOM2012¶ | 12.6 (28.4) | 57 (49 to 64) | 222 | −14 (−20 to −9) | 150 | −13 (−18 to −8) | 56 528 | 37 (32 to 41) |
| Other proposed thresholds | |||||||||
| 1.51% 6-y lung cancer risk** | PLCOM2012¶ | 11.3 (25.5) | 41 (34 to 47) | 207 | −7 (−12 to −1) | 141 | −6 (−12 to −1) | 54 456 | 32 (28 to 36) |
| 1.2% 5-y lung cancer death risk†† | LCDRAT‡‡ | 9.0 (20.4) | 12 (5 to 20) | 168 | 14 (8 to 19) | 119 | 10 (5 to 15) | 53 732 | 30 (25 to 35) |
| Thresholds required to screen as many ever-smokers as USPSTF guidelines in 2015 (8.0 million) | |||||||||
| 2.19% 6-y lung cancer risk | PLCOM2012¶ | 8.0 (18.1) | 0 (−6 to 6) | 169 | 13 (7 to 19) | 119 | 10 (5 to 15) | 47 401 | 14(11 to 19) |
| 1.33% 5-y lung cancer death risk | LCDRAT‡‡ | 8.0 (18.1) | −1 (−7 to 6) | 156 | 20 (14 to 25) | 112 | 15 (10 to 21) | 51 019 | 24 (19 to 28) |
CT = computed tomography; LCDRAT = Lung Cancer Death Risk Assessment Tool; NA = not applicable; NCCN = National Comprehensive Cancer Network; NHIS = National Health Interview Survey; NNS = number needed to screen; PLCOM2012 = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012; USPSTF = U.S. Preventive Services Task Force.
Multiple imputation was used to account for missing data (1.8% for race, 0.4% for education, 2.9% for body mass index, 0.4% for number of years since quitting, 7.3% for number of cigarettes smoked per day, 0.3% for number of years of smoking, 0.2% for presence of emphysema, and 12.1% for family history of lung cancer).
We estimate there would be 202 442 lung cancer deaths without screening. The number prevented with each risk threshold/model combination was estimated using the LCDRAT.
Obtained using the delta method.
Guidelines recommend annual screening with low-dose CT for adults aged 55-80 y with a 30-pack-year smoking history and ≥15 y since quitting.
1.34% 6-y lung cancer risk according to the PLCOM2012 was chosen to select the same proportion of ever-smokers as were eligible according to the USPSTF guidelines in the PLCO (1993-2001) cohort (38%) (4). The NCCN criterion is 1.3% (not 1.34%) 6-y lung cancer risk according to the PLCOM2012.
Reference 5.
Chosen to select 35% of ever-smokers at highest risk in the PLCO (1993-2001) cohort (4).
Selects the same number of ever-smokers who were eligible according to the USPSTF guidelines in the 2010-2012 NHIS (9.0 million).
Reference 2.