Table 5.
Benefits and harms of the USPSTF criteria and selected LCDRAT model screening strategies (screening age 55–80 y) in a 1960 cohort
| 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 | 13.8 (12.8–14.3) | 227 823 (225 769–229 664) | 387 (204–587) | 8.3 (5.1–13.2) | 5352 (2822–7736) | 13.8 (13.2–15.6) | 71 (29–101) | 7.1 (5.2–10.4) | 588 (386–1124) | 43 (29–82) | 16 (16–18) | 56.6 (56.2–57.6) |
| Similar proportion of individuals selected as the USPSTF criteria’s in the PLCO control arm | 0.96 | 28.2 (26.3–28.9) | 411 064 (409 654–412 742) | 581 (346–853) | 12.5 (8.6–19.2) | 7680 (4441–10 638) | 13.2 (12.5–14.7) | 112 (52–155) | 7.4 (5.4–10.3) | 707 (484–1189) | 54 (39–94) | 15 (14–16) | 63.7 (63.2–65.1) |
| Similar sensitivity as the USPSTF criteria’s in the PLCO control arm | 1.34 | 21.8 (20.3–22.4) | 313 782 (313 165–314 698) | 520 (289–776) | 11.2 (7.2–17.4) | 6660 (3552–9416) | 12.8 (12.1–14.2) | 103 (45–143) | 7.4 (5.5–10.1) | 604 (406–1086) | 47 (33–89) | 14 (14–15) | 63.4 (63.0–64.7) |
| Similar CT screens required as the USPSTF criteria’s | 1.70 | 19.0 (17.7–19.5) | 254 053 (253 337–254 860) | 471 (248–712) | 10.1 (6.2–16.0) | 5880 (2926–8453) | 12.5 (11.8–13.8) | 97 (40–137) | 7.5 (5.7–9.8) | 540 (358–1027) | 43 (30–88) | 13 (13–14) | 64.4 (63.9–65.6) |
| Similar lung cancer deaths averted as the USPSTF criteria’s | 2.10 | 16.5 (15.4–17.0) | 200 646 (199 830–202 045) | 415 (211–630) | 8.9 (5.3–14.1) | 5020 (2404–7234) | 12.1 (11.4–13.4) | 90 (35–127) | 7.6 (5.9–9.6) | 483 (319–957) | 40 (28–84) | 12 (12–13) | 65.6 (65.2–66.8) |
| Similar life-years gained as the USPSTF criteria’s | 1.70 | 19.0 (17.7–19.5) | 254 053 (253 337–254 860) | 471 (248–712) | 10.1 (6.2–16.0) | 5880(2926–8453) | 12.5 (11.8–13.8) | 97 (40–137) | 7.5 (5.7–9.8) | 540 (358–1027) | 43 (30–88) | 13 (13–14) | 64.4 (63.9–65.6) |
Results are per 100 000 individuals alive at age 45 years. Lung cancer incidence in the no-screening strategy group was 5870 (5278–6752) per 100 000 persons; lung cancer mortality was 4643 (4016–5307) 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; CT = computed tomography; LCDRAT = Lung Cancer Death Risk Assessment Tool; PLCO = Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial; USPSTF = United States Preventive Services Task Force.