Table 2:
Projected outcomes from 3 strategies for selecting US ever-smokers for screening
| Life-gained-based * | Risk-based † | USPSTF ‡ | ||||
|---|---|---|---|---|---|---|
| Est. | 95% CI | Est. | 95% CI | Est. | 95% CI | |
| Screen-eligible ever-smokers, millions | 8.3 | (7.9, 8.7) | 8.3 | (7.9, 8.7) | 8.3 | (7.9, 8.7) |
| % of all screen-detectable cases§ | 56.0% | (54.5%, 57.4%) | 57.3% | (55.9%, 58.8%) | 44.8% | (43.2%, 46.5%) |
| % of all Lung cancer deaths§ | 58.5% | (57.1%, 60.0%) | 61.3% | (59.9%, 62.6%) | 46.0% | (44.4%, 47.7%) |
| % of all Life-years gained§ | 47.9% | (46.6%, 49.2%) | 46.0% | (44.6%, 47.3%) | 40.7% | (39.4%, 42.1%) |
| Screen-detected cases after 5 y, thousands | 438 | (413, 463) | 449 | (424, 475) | 351 | (329, 373) |
| Lung cancer deaths averted after 5 y, thousands | 52.6 | (49.6, 55.5) | 55.0 | (52.0, 58.1) | 41.3 | (38.8, 43.9) |
| Life-years gained, thousands | 633 | (602, 665) | 608 | (577, 639) | 538 | (510, 567) |
| NNS per LCD averted | 158 | (152, 164) | 151 | (146, 156) | 201 | (191, 210) |
| NNS per 10 LYG | 131 | (128, 134) | 136 | (133.2, 140) | 154 | (149 159) |
| LYG per screen-detected case ∥ | 1.45 | (1.42, 1.48) | 1.35 | (1.33, 1.38) | 1.53 | (1.50, 1.57) |
| LYG per LCD averted ¶ | 12.1 | (11.8, 12.3) | 11.1 | (10.8, 11.3) | 13.0 | (12.7, 13.4) |
| Number of false positives, millions | 5.9 | (5.7, 6.2) | 6.0 | (5.7, 6.3) | 5.6 | (5.4, 5.9) |
| Number of false positives per LCD averted | 113 | (109, 117) | 109 | (105, 112) | 137 | (131, 142) |
| Number of false positives per 10 LYG | 93.7 | (92.0, 95.4) | 98.3 | (96.3, 100) | 105 | (102, 107) |
Abbreviations: USPSTF = U.S. Preventive Service Task Force; LCD = lung cancer death, LYG = life years gained, NNS = number needed to screen
Life-gained-based selection of 8.3 million – age 40-84, gain in life-expectancy from undergoing CT screening of at least 16.2 days
Risk-based selection of 8.3 million – age 40-84, 5-year lung cancer death risk of 1.4% or greater, as estimated by the Lung cancer Death Risk Assessment Tool (LCDRAT) (Katki et al., 2016)
USPSTF criteria – age 55-80, smoked in past 15 years, 30 pack-years
Percentage are calculated by comparing against the number of lung cancer incidence, lung cancer deaths, and life-gained that would occur if all U.S. ever-smokers, aged 40-84 years, were screened.
Life years gained per screen-detected cases = total life years gained in the screened population divided by the total number of screen-detected cases
Life years gained per lung cancer death averted = total life years gained in the screened population divided by the total number of averted lung cancer deaths.