Evaluating lung cancer screening by competing mortality

Principal Investigator

Name
Rebecca Landy

Degrees
PhD

Institution
American Cancer Society

Position Title
Principal Scientist

Email
rebecca.landy@cancer.org

About this CDAS Project

Study
NLST (Learn more about this study)

Project ID
NLST-1496

Initial CDAS Request Approval
Jan 29, 2026

Title
Evaluating lung cancer screening by competing mortality

Summary
The NLST showed that 3 annual low-dose CT screens reduced 5-year lung cancer mortality by 20%. Lung cancer screening has been recommended by the United States Preventive Services Task Force (USPSTF) since 2013, and is currently recommended for individuals aged 50-80 with ≥20 pack years who currently smoke or quit within the past 15 years.

Lung cancer screening is most beneficial for individuals at both high risk of lung cancer death and low risk of death from other causes. However, many of the risk factors that increase an individual’s risk of dying from lung cancer, for example smoking history and COPD/emphysema, also increase risk of competing mortality via comorbidities such as lung disease or heart disease. Thus, some individuals who are predicted to have a high risk of lung cancer incidence and lung cancer death are expected to have little benefit from lung cancer screening, even if their lung cancer death is prevented, because they would die from other causes shortly after.

We aim to incorporate competing mortality into our prediction modeling, and evaluate the impact of this on the potential population level benefit of lung cancer screening using data from the National Health Interview Survey.

Aims

1. To develop a Cox model for competing mortality using data from the NLST chest radiography arm. We will consider sociodemographic variables (age, race, sex, education), smoking data, emphysema, and a range of comorbidities including diabetes, chronic bronchitis, heart disease and other lung conditions.

2. To develop a Cox model for lung cancer mortality using data from the NLST chest radiography (control) arm.

3. To model the reduction in lung cancer mortality resulting from low-dose CT by competing mortality quintile.

4. To evaluate the population level benefit of lung cancer screening among screening eligible individuals using the new model developed.

Collaborators

Rebecca Landy American Cancer Society
Hormuzd Katki American Cancer Society
J Will Correira American Cancer Society