Real-World Effectiveness of Lung Cancer Screening Using Deep Learning-Based Counterfactual Prediction

The benefits and harms of lung cancer screening (LCS) for patients in the real-world clinical setting have been argued. Recently, discriminative prediction modeling of lung cancer with stratified risk factors has been developed to investigate the real-world effectiveness of LCS from observational data. However, most of these studies were conducted at the population level that only measured the difference in the average outcome between groups. In this study, we built counterfactual prediction models for lung cancer risk and mortality and examined for individual patients whether LCS as a hypothetical intervention reduces lung cancer risk and subsequent mortality. We investigated traditional and deep learning (DL)-based causal methods that provide individualized treatment effect (ITE) at the patient level and evaluated them with a cohort from the OneFlorida+ Clinical Research Consortium. We further discussed and demonstrated that the ITE estimation model can be used to personalize clinical decision support for a broader population.