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The Benefits and Harms of Lung Cancer Screening in Individuals With Comorbidities
Minal S Kale1, Keith Sigel1,2, Arushi Arora1,3
1Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
JTO Clinical and Research Reports
|March 7, 2024
Summary
Chronic diseases, such as COPD and diabetes, reduce the life-years gained from lung cancer screening. This finding is crucial for clinicians discussing screening benefits and harms with patients who have comorbidities.
Area of Science:
- Oncology
- Public Health
- Epidemiology
Background:
- Individuals at high risk for lung cancer often have smoking-related comorbidities.
- Comorbidities can affect the benefit-to-harm ratio of lung cancer screening.
- Chronic diseases are underrepresented in lung cancer screening trials.
Purpose of the Study:
- To determine the impact of chronic diseases on lung cancer screening benefits and harms.
- To quantify life-years gained from lung cancer screening in individuals with specific comorbidities.
Main Methods:
- A validated lung cancer screening microsimulation model was extended.
- The model incorporated the impact of chronic diseases on complications, quality of life, and mortality.
- Outcomes were life-years gained per 100,000 individuals aged 50-80 with chronic obstructive pulmonary disease, diabetes mellitus, heart disease, or history of stroke.
Main Results:
- Comorbidities reduced life-years gained from lung cancer screening compared to individuals without comorbidities.
- For ages 50-54, life-years gained varied: 4296 (no comorbidities), 3462 (COPD), 3260 (heart disease), 3031 (diabetes mellitus), and 3257 (stroke).
- Greater reductions in life-years gained were observed in individuals with multiple comorbidities, with similar patterns across all age groups studied.
Conclusions:
- Comorbidities significantly decrease the life-years gained from lung cancer screening.
- These findings can assist clinicians in counseling patients with comorbidities about lung cancer screening.
- The study highlights the need to consider individual patient health status when evaluating screening efficacy.
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