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  1. Mamta Ruparel
  1. Correspondence to Dr Mamta Ruparel, Lungs for Living Research Centre, UCL Respiratory, University College London, London WC1E 6JF, UK; m.ruparel{at}

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Does risk based entry to lung cancer screening improve programme efficiency?

Lung cancer screening has the potential to save lives, though optimum methods for implementation in a cost-effective manner are yet to be determined. The PANCAN study (Lancet Oncol 2017;18:1523–31) was the first screening study that used a lung cancer risk prediction algorithm to determine entry into screening. This single-arm prospective study recruited 2537 individuals aged 50–75 with a 2% 6-year risk of lung cancer as calculated by the ‘PANCAN’ risk prediction model, a precursor to the PLCOm2012 model. The investigators report a higher incidence of lung cancers (6.5%) compared with the National Lung Screening Trial (NLST, 4%; P<0.001) and a higher proportion of early stage cancers (77% vs. 57% in NLST and 25% in Canadian non-screening registry data, P<0.001). This suggests scope for an equivalent or better mortality benefit than that reported in NLST. Another interesting finding is the low rate of cancers in patients with no nodules (n=1) compared with those with nodules >1 mm (n=85) and supports the use …

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