Heterogeneity of screening effects (Original Project: NLST-1098)

Principal Investigator

Name
Hormuzd Katki

Degrees
Ph.D.

Institution
American Cancer Society

Position Title
Scientific Vice President, Center for Early Cancer Detection

Email
hormuzd.katki@cancer.org

About this CDAS Project

Study
NLST (Learn more about this study)

Project ID
NLST-1509

Initial CDAS Request Approval
May 29, 2026

Title
Heterogeneity of screening effects (Original Project: NLST-1098)

Summary
We will examine heterogeneity of screening effects in NLST by various factors. This is because, screening individuals at the highest lung-cancer risk may be incorrect. Lung-cancer screening is most beneficial for individuals at both high risk of lung-cancer death and low risk of death from other causes (competing-mortality). That is, some high-risk individuals will have little benefit from lung-cancer screening, even if their lung-cancer death is prevented, because they would die from other causes shortly after. Unfortunately many lung-cancer risk-factors (e.g. smoking history, demographics) also increase the risk of competing-mortality via comorbidities such as lung disease, heart disease, or diabetes. Thus we will examine if the effect of screening is modified by factors that affect competing-mortality

Aims

How competing-mortality affects CT-screening effectiveness is unknown. We will analyze NLST data to calculate individualized competing-mortality risk (based on demographics, risk-factors, and comorbid conditions) and evaluate variation in the lung-cancer mortality reduction for CT-screening by quintiles of competing-mortality risk. We also examine variation in reduction in stage-4 lung-cancer incidence by quintiles of competing-mortality risk, because late-stage incidence is considered a reliable surrogate for mortality reductions from lung screening.
* We will look if risk factors (such as age, race, sex, etc) modify the effect of screening
* We will look at how effects of screening varying by screening test results
* We will focus on comorbidities, complications, and treatments

Collaborators

Li Cheung NCI
Hormuzd Katki American Cancer Society
Rebecca Landy American Cancer Society