Risk-Based Lung Cancer Screening in Clinical Practice.

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Current U.S. lung cancer screening guidelines rely solely on age and smoking history.
• Individualized risk assessment tools may offer superior risk stratification for lung cancer.

Purpose of the Study:

• To evaluate the effectiveness of the PLCO_m2012 risk calculator in identifying lung cancer.
• To compare lung cancer detection rates between USPSTF₂₀₁₃ and PLCO_m2012 criteria.

Main Methods:

• A multisite lung cancer screening program enrolled patients qualifying via USPSTF₂₀₁₃ or PLCO_m2012 (≥1.34% risk).
• Retrospective abstraction of invasive procedures was performed.
• Lung cancer incidence and prevalence were compared across risk strata defined by PLCO_m2012.

Main Results:

• 114 lung cancers were detected in 2471 screened patients.
• 84% of all patients and 91% of those diagnosed with cancer met both USPSTF₂₀₁₃ and PLCO_m2012 criteria.
• Lung cancer prevalence was over 7 times higher in the highest PLCO_m2012 risk group compared to the lowest. Incidence was higher for PLCO_m2012-only qualifiers (3.6/1000 person-years) versus USPSTF₂₀₁₃-only qualifiers (0/1000 person-years).
• 74% of screen-detected NSCLC was Stage I or II. Invasive interventions for screening were low (4.3%).

Conclusions:

• The PLCO_m2012 risk calculator identifies more lung cancers, particularly in patients not meeting USPSTF₂₀₁₃ criteria alone.
• Lung cancer prevalence and incidence increase with higher prospective risk scores.
• Lung cancer screening using risk-based criteria demonstrates a low rate of invasive procedures for benign conditions.