Kevin ten Haaf

MSc

Erasmus MC

Junior researcher

PLCO (Learn more about this study)

PLCO-83

May 2, 2014

Individualized-risk based computed tomography lung cancer screening strategies: an evaluation using comparative microsimulation modeling

The United States Preventive Services Task Force (USPSTF) recommends annual screening to smokers aged 55 through 80, who smoked at least 30 pack-years and quit less than 15 years ago, based on Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Model extrapolations which investigated eligibility criteria based on age, pack-years and years since cessation. 1 2

However, recent publications argue that eligibility based on individualized risk could lead to more effective screening programs compared to the National Lung Screening Trial (NLST) criteria, which were based on age, pack-years and years since cessation.3 4 Investigating the long term harms and benefits of screening programs with eligibility based on individualized risk is therefore of great interest.

In this project, the CISNET-Lung Group will investigate screening programs based on individualized risk. Lung cancer screening strategies based on several individualized lung cancer (death) risk models, such as the PLCOm2012 model, will be investigated.4

We will use data from the NLST and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) to determine suitable risk thresholds for screening eligibility for each individual risk model. These models and risk thresholds will be applied to individuals from a 1950 U.S. cohort, to determine their screening eligibility for each risk model and risk threshold.

The individualized risk-based programs will then be investigated using microsimulation modeling. This allows us to investigate the future harms and benefits of implementing these programs, such as the number of lung cancer deaths averted, the number of life-years gained and the number of overdiagnosed cases.

References:

1. Moyer VA. Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2013.
2. de Koning HJ, Meza R, Plevritis SK, et al. Benefits and Harms of Computed Tomography Lung Cancer Screening Strategies: A Comparative Modeling Study for the U.S. Preventive Services Task Force Ann Intern Med 2013; [published online ahead of print December 31, 2013], doi: 10.7326/M13-2316.
3. Aberle DR, Adams AM, Berg CD, et al. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med 2011;365(5):395-409.
4. Tammemägi MC, Katki HA, Hocking WG, et al. Selection Criteria for Lung-Cancer Screening. N Engl J Med 2013;368(8):728-36.