Table 4.
Benefits and harms of the USPSTF criteria and selected PLCOm2012 model screening strategies with a hypothetical life-expectancy assessment (screening age 55–80 y) compared with no screening*
| Strategy description | Corresponding risk threshold, % | Percentage ever screened, % (CMR†) | Number of CT screens per 100 000 (CMR) | Lung cancer deaths prevented per 100 000 (CMR) | Lung cancer mortality reduction, % (CMR) | Life-years gained per 100 000 (CMR) | Life-years gained per lung cancer death prevented (CMR) | Number of overdiagnosed lung cancers per 100 000 (CMR) | Percentage of screen-detected cases overdiagnosed, % (CMR) | Average number of screens per lung cancer death avoided (CMR) | Average number of screens per life-year gained (CMR) | Average number of screens per person screened (CMR) | Average age at first screening (CMR), y |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| USPSTF criteria | USPSTF criteria | 19.1 (18.0–20.3) | 297 036 (269 853–308 570) | 586 (322–837) | 10.3 (6.4–16.4) | 8602 (4648–12 066) | 14.7 (13.4–16.1) | 39 (20–61) | 3.2 (1.3–6.5) | 507 (365–959) | 35 (25–66) | 16 (15–17) | 55.7 (55.7–55.8) |
| Similar proportion of individuals selected as the USPSTF criteria’s in the PLCO control arm | 1.36 | 24.6 (22.9–26.9) | 357 735 (326 256–372 335) | 720 (393–1038) | 12.7 (7.8–20.3) | 9861 (5186–13 418) | 13.7 (12.6–15.0) | 52 (30–81) | 3.3 (1.5–6.3) | 497 (359–944) | 36 (27–72) | 15 (14–16) | 61.7 (61.6–61.9) |
| Similar sensitivity as the USPSTF criteria’s in the PLCO control arm | 1.83 | 20.6 (19.0–22.8) | 270 445 (245 877–281 949) | 641 (325–929) | 11.3 (6.5–18.2) | 8498 (4181–11 744) | 13.3 (12.2–14.4) | 48 (28–75) | 3.2 (1.5–5.7) | 422 (303–867) | 32 (23–67) | 13 (12–15) | 63.2 (63.1–63.5) |
| Similar CT screens required as the USPSTF criteria’s | 1.70 | 21.6 (20.0–23.9) | 291 528 (265 273–303 765) | 655 (342–951) | 11.6 (6.8–18.6) | 8807 (4421–12 131) | 13.4 (12.3–14.8) | 49 (29–76) | 3.3 (1.5–5.8) | 445 (319–888) | 33 (24–69) | 14 (13–15) | 62.9 (62.7–63.1) |
| Similar lung cancer deaths averted as the USPSTF criteria’s | 2.20 | 18.2 (16.7–20.3) | 220 749 (200 188–231 189) | 579 (281–851) | 10.2 (5.6–18.6) | 7481 (3484–10 428) | 12.9 (11.9–14.1) | 45 (24–71) | 3.2 (1.6–5.3) | 381 (271–824) | 30 (21–66) | 12 (11–14) | 64.4 (64.2–64.6) |
| Similar life-years gained as the USPSTF criteria’s | 1.83 | 20.6 (19.0–22.8) | 270 445 (245 877–281 949) | 641 (325–929) | 11.3 (6.5–18.2) | 8498 (4181–11 744) | 13.3 (12.2–14.4) | 48 (28–75) | 3.2 (1.5–5.7) | 422 (303–867) | 32 (23–67) | 13 (12–15) | 63.2 (63.1–63.5) |
Results are per 100 000 individuals alive at age 45 years. Lung cancer incidence in the no-screening strategy group was 7116 (6518–8450) per 100 000 persons; lung cancer mortality was 5670 (5010–7114) per 100 000 persons.
All results were summarized as the mean across the four CISNET models. The numbers in parentheses denote the lower and upper range of the results across the four CISNET models.
CISNET = Cancer Intervention and Surveillance Modeling Network; CMR = CISNET model range; PLCO = Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; USPSTF = United States Preventive Services Task Force.