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Multidimensional Coculture System to Model Lung Squamous Carcinoma Progression

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Personalizing lung cancer screening recommendations for heterogeneous populations: a microsimulation study.

Joshua B Rager^1,2,3, Pianpian Cao⁴, Rodney A Hayward^5,6

¹Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.

Journal of the National Cancer Institute

|November 3, 2025

Summary

Personalizing lung cancer screening (LCS) recommendations can improve outcomes. Current guidelines may exclude many eligible ever-smokers who could benefit from LCS.

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Area of Science:

Pulmonary Medicine
Preventive Health
Health Economics

Background:

Personalizing lung cancer screening (LCS) recommendations is challenging due to varied net benefit.
Exploring net benefit thresholds can guide personalized LCS decisions.

Purpose of the Study:

To explore individual and population implications of net benefit thresholds for LCS.
To compare personalized LCS recommendations with current USPSTF guidelines.

Main Methods:

Microsimulation used to estimate individualized quality-adjusted life years saved with LCS in a simulated US population (40-80 years old, ever-smokers).
Identified net benefit thresholds accounting for patient preferences and uncertainties.
Compared personalized approach to USPSTF guidelines.

Main Results:

59 million simulated US adults (40-80, ever-smokers); 15 million USPSTF eligible.
Half of USPSTF-eligible population shows high net benefit for LCS.
Current criteria exclude 2.5 million high-net-benefit and 20.5 million intermediate-net-benefit ever-smokers.

Conclusions:

Half of USPSTF-eligible population could be routinely encouraged for LCS.
Current LCS eligibility criteria may exclude many high-net-benefit and intermediate-net-benefit ever-smokers.