medwireNews: Using a life–years gained approach to select patients for lung cancer screening could maximize its benefits for current and ex-smokers who have both a high risk for lung cancer and a long life expectancy, US research suggests.
However, Li Cheung (National Institutes of Health, Bethesda, Maryland) and co-investigators note that compared with risk-based selection for screening, this approach results in the prevention of fewer lung cancer deaths.
Discussing the public health implications of their findings in the Annals of Internal Medicine, the researchers say: “As lung cancer screening moves toward risk-based selection strategies, screening programs would increasingly include older persons with multiple comorbidities, which might inadvertently limit the population-level benefit of screening.”
They add: “Our life-gained–based framework could aid in the development of lung cancer screening guidelines such that benefits are maximized; harms are minimized; and the number of prevented deaths, effectiveness, and efficiency are maintained at high levels.”
Cheung and team developed and validated the Life Years gained From Screening-computed tomography (LYFS-CT) model to enable selection of people for lung cancer screening based on the number of life–years they are likely to gain.
The researchers then compared outcomes of a National Lung Screening Trial–like CT screening program (three annual screenings plus 5 years of follow-up) for people selected by the LYFS-CT model with those of patients selected based on the Lung Cancer Death Risk Assessment Tool (LCDRAT) and the US Preventive Services Task Force (USPSTF) criteria (aged 55–80 years, ≥30 pack–years of smoking, and ≤15 years since quitting).
They report that, among 8.3 million members of the US population aged 40 to 84 years who had ever smoked (selected to match the number selected by the USPSTF criteria in 2013 to 2015), selection for screening using the LYFS-CT model would increase the total number of life–years gained by 633,000 compared with no screening. The corresponding increases among those selected using the LCDRAT tool and the USPSTF criteria were 608,000 and 538,000.
The number of deaths prevented using the life–years gained, risk-based, and USPSTF selection criteria were 52,600, 55,000, and 41,300, respectively.
The researchers note that there were 1.56 million people selected for screening by the LYFS-CT but not the LCDRAT criteria. These people were younger than those selected by the risk-based strategy (mean 59 vs 75 years), were more likely to be women (47.7 vs 33.7%) and current smokers (76.7 vs 20.8%), and had fewer comorbidities (mean 0.8 vs 3.7).
Writing in an accompanying editorial, Tanner Caverly and Rafael Meza, both from the University of Michigan in Ann Arbor, USA, say that both the life–years gained and risk-based models “can greatly improve our ability to estimate benefit for individual patients and can substantially improve the effectiveness, safety, and patient-centeredness of lung cancer screening programs.”
They add: “Screening guidelines should strongly consider a transition to newer methods that are likely to deliver better care.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
Ann Intern Med 2019; doi:10.7326/M19-1263
Ann Intern Med 2019; doi:10.7326/M19-2869