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About this Publication
Management of lung cancer screening results based on individual prediction of current and future lung cancer risk.
Pubmed ID
34648946 (View this publication on the PubMed website)
Digital Object Identifier
J Thorac Oncol. 2021 Oct 11

Robbins HA, Cheung LC, Chaturvedi AK, Baldwin DR, Berg CD, Katki HA


OBJECTIVE: We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and LDCT image features into calculations of immediate and next-screen (1-year) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals.

METHODS: We first extended the "LCRAT+CT" individualized risk calculator to predict lung cancer risk after either a negative or abnormal LDCT screen. To develop the abnormal screens portion, we analyzed 18,129 abnormal LDCTs in the National Lung Screening Trial (NLST), including lung cancers detected immediately (n=649) or at the next screen (n=235). We estimated the potential impact of this approach among NLST participants with any screen result (negative or abnormal).

RESULTS: Applying the draft National Health Service (NHS) England protocol for lung screening to NLST participants referred 76% of participants to a 2-year interval, but delayed diagnosis for 40% of detectable cancers. The LCRAT+CT risk model, with a threshold of <0.95% cumulative lung-cancer risk, would also refer 76% of participants to a 2-year interval, but would delay diagnosis for only 30% of cancers, a 25% reduction versus the NHS protocol. Alternatively, LCRAT+CT, with a threshold of <1.7% cumulative lung-cancer risk, would also delay diagnosis for 40% of cancers, but would refer 85% of participants for a 2-year interval, a 38% further reduction in the number of required 1-year screens beyond the NHS protocol.

CONCLUSIONS: Using individualized risk models to determine management in lung cancer screening could substantially reduce the number of screens or increase early detection.

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