Performance of Lung Cancer Risk Prediction Models in Different Racial and Ethnic Groups in the United States: Results From the Lung Cancer Cohort Consortium.

Authors

Feng X, Guida F, Guenoun A, Alcala K, Aldrich MC, Arslan AA, Cai Q, Zheng W, Chen C, Triplette M, Tinker LF, Patel AV, Liao LM, Sinha R, Rohan TE, Sesso HD, Zhang X, Visvanathan K, Wang Y, Johansson M, ...show more Robbins HA

Affiliations

• Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, Lyon, France (X.F., A.G., K.A., M.J., H.A.R.).
• Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, Lyon, France (F.G.).
• Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee (M.C.A.).
• Departments of Obstetrics and Gynecology and Population Health, New York University Grossman School of Medicine, New York, New York (A.A.A.).
• Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee (Q.C., W.Z.).
• Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington (C.C., M.T.).
• Women's Health Initiative Clinical Coordinating Center, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington (L.F.T.).
• Department of Population Science, American Cancer Society, Atlanta, Georgia (A.V.P., Y.W.).
• Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland (L.M.L., R.S.).
• Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York (T.E.R.).

Abstract

BACKGROUND: Racial and ethnic disparities are a concern in lung cancer screening.

OBJECTIVE: To investigate the performance of risk prediction models to define screening eligibility across 4 U.S. racial and ethnic groups.

DESIGN: Cohort study.

SETTING: United States, Lung Cancer Cohort Consortium.

PARTICIPANTS: 641 830 participants aged 50 to 80 years with a smoking history from 12 U.S. cohorts, including 6390 Asian, 9781 Hispanic, 39 872 non-Hispanic Black, and 585 787 non-Hispanic White participants.

MEASUREMENTS: Calibration and discrimination were quantified for 16 lung cancer prediction models. Then, screening-related metrics were calculated after applying model thresholds to select the same number of eligible participants as the 2021 criteria from the U.S. Preventive Services Task Force (USPSTF-2021). These included eligibility, sensitivity, and efficiency measured as estimated number needed to screen (NNS; the ratio between participants and lung cancer cases) for each strategy or prediction model in each racial and ethnic group.

RESULTS: General patterns across the 16 models included substantial underestimation of lung cancer risk in non-Hispanic Black participants (expected-observed ratio < 0.75 for 11 of 16 models), lower discrimination in Asian participants than all other groups (13 of 16 models), and lower discrimination in non-Hispanic Black than non-Hispanic White participants (15 of 16 models). When a same-sized screening-eligible population as USPSTF-2021 (38.0%) was enforced, all risk-based strategies achieved better average estimated screening efficiency and reduced racial and ethnic differences in efficiency compared with USPSTF-2021. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Model 2012 (PLCOm2012) and Life Years gained From Screening-Computed Tomography model (LYFS-CT) performed best (mean estimated NNS, 36.5 [SD, 8.8] and 40.1 [SD, 8.2], respectively). However, no strategy could simultaneously optimize eligibility, sensitivity, and efficiency while also reducing racial and ethnic differences.

LIMITATION: Smaller sample for Asian and Hispanic participants.

CONCLUSION: To optimize efficiency and minimize its variation across racial and ethnic groups, risk-based strategies were superior to USPSTF criteria. Further optimization of prediction models for the diverse U.S. population is needed.

PRIMARY FUNDING SOURCE: U.S. National Cancer Institute, Lung Cancer Research Foundation, and Cancer Research UK.