Brief Report: Risk Prediction Model Versus United States Preventive Services Task Force 2020 Draft Lung Cancer
Mary M Pasquinelli1, Martin C Tammemägi2, Kevin L Kovitz1
1Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
JTO Clinical and Research Reports
|September 30, 2021
Summary
The PLCOm2012 risk model demonstrates higher sensitivity and eliminates race disparity in lung cancer screening eligibility compared to the proposed USPSTF2020 criteria. This finding supports its use for more equitable lung cancer detection.
Area of Science:
- Pulmonology
- Radiology
- Oncology
Background:
- Lung cancer screening eligibility criteria significantly impact early detection rates.
- Current age and smoking history guidelines have limitations in sensitivity and can exhibit racial disparities.
- Validated risk prediction models offer improved accuracy for identifying high-risk individuals.
Purpose of the Study:
- To compare the sensitivity of the proposed USPSTF2020 criteria against the PLCOm2012 risk prediction model for lung cancer screening.
- To evaluate the effectiveness of these criteria in selecting a racially diverse population with a history of smoking.
- To identify potential race disparities in lung cancer screening eligibility.
Main Methods:
- Retrospective analysis of the Chicago Race Eligibility for Screening Cohort (CRESC) study.
- Application of the PLCOm2012 model (1.0%/6 years risk threshold) and USPSTF2020 criteria (age 50-80, ≥20 pack-years, ≤15 quit-years) to 883 lung cancer patients.
- Comparison of screening eligibility and sensitivity between the two models across different racial groups.
Main Results:
- The PLCOm2012 model showed significantly higher overall sensitivity (79.1%) compared to USPSTF2020 (68.6%).
- PLCOm2012 demonstrated superior sensitivity in both White (81.5% vs. 75.4%) and African American (82.8% vs. 70.6%) individuals.
- USPSTF2020 criteria excluded 28.8% of cases, 40% of which would have qualified under PLCOm2012; notably, 19.3% of African American individuals did not meet the pack-year criterion but would have qualified with PLCOm2012.
Conclusions:
- The proposed USPSTF2020 guidelines, while an improvement over USPSTF2013, still exhibit racial disparities in lung cancer screening eligibility.
- The PLCOm2012 risk prediction model proves more sensitive and effectively eliminates race disparity in identifying eligible candidates for lung cancer screening.
- Real-world evidence supports the PLCOm2012 model for more equitable and effective lung cancer screening.
