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Original research
Analysis of lung cancer risk model (PLCOM2012 and LLPv2) performance in a community-based lung cancer screening programme
  1. Mikey B Lebrett1,2,
  2. Haval Balata1,3,
  3. Matthew Evison3,
  4. Denis Colligan4,5,
  5. Rebecca Duerden3,6,
  6. Peter Elton7,
  7. Melanie Greaves3,6,
  8. John Howells8,
  9. Klaus Irion6,
  10. Devinda Karunaratne6,
  11. Judith Lyons3,
  12. Stuart Mellor9,
  13. Amanda Myerscough4,
  14. Tom Newton9,
  15. Anna Sharman3,6,
  16. Elaine Smith3,6,
  17. Ben Taylor10,
  18. Sarah Taylor4,11,
  19. Anna Walsham12,
  20. James Whittaker13,
  21. Phil V Barber3,
  22. Janet Tonge14,
  23. Hilary A Robbins15,
  24. Richard Booton1,3,16,
  25. Philip A J Crosbie1,2,3
  1. 1 Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
  2. 2 Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK
  3. 3 Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
  4. 4 South Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
  5. 5 Manchester Health and Care Commissioning, Manchester, Manchester, UK
  6. 6 Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
  7. 7 Greater Manchester and Eastern Cheshire Strategic Clinical Networks, Manchester, Manchester, UK
  8. 8 Department of Radiology, Royal Preston Hospital, Preston, Lancashire, UK
  9. 9 Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
  10. 10 Department of Radiology, Christie NHS Foundation Trust, Manchester, Manchester, UK
  11. 11 Manchester Health and Care Commissioning, Manchester, UK
  12. 12 Department of Radiology, Salford Royal NHS Foundation Trust, Salford, Salford, UK
  13. 13 Department of Radiology, Stockport NHS Foundation Trust, Stockport, Stockport, UK
  14. 14 Academic Unit of Primary Care, University of Leeds Leeds Institute of Health Sciences, Leeds, Manchester, UK
  15. 15 International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
  16. 16 Manchester Academic Health Science Centre, Manchester, Manchester, UK
  1. Correspondence to Dr Philip A J Crosbie, Division of Infection, Immunity and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester M13 9PL, UK; philip.crosbie{at}manchester.ac.uk

Abstract

Introduction Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCOM2012 and Liverpool Lung Project model (LLPv2)) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme.

Methods Ever-smokers aged 55–74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCOM2012 score ≥1.51%) were offered annual LDCT screening over two rounds. LLPv2 score was calculated but not used for screening selection; ≥2.5% and ≥5% thresholds were used for analysis.

Results PLCOM2012 ≥1.51% selected 56% (n=1429) of LHC attendees for screening. LLPv2 ≥2.5% also selected 56% (n=1430) whereas NLST (47%, n=1188) and LLPv2 ≥5% (33%, n=826) selected fewer. Over two screening rounds 62 individuals were diagnosed with LC; representing 87% (n=62/71) of 6-year incidence predicted by mean PLCOM2012 score (5.0%). 26% (n=16/62) of individuals with LC were not eligible for screening using LLPv2 ≥5%, 18% (n=11/62) with NLST criteria and 7% (n=5/62) with LLPv2 ≥2.5%. NLST eligible Manchester attendees had 2.5 times the LC detection rate than NLST participants after two annual screens (≈4.3% (n=51/1188) vs 1.7% (n=438/26 309); p<0.0001). Adverse measures of health, including airflow obstruction, respiratory symptoms and cardiovascular disease, were positively correlated with LC risk. Coronary artery calcification was predictive of LC (adjOR 2.50, 95% CI 1.11 to 5.64; p=0.028).

Conclusion Prospective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCOM2012 model may underestimate risk in deprived UK populations; further research focused on model calibration is required.

  • lung cancer
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Twitter @MLebrett, @JetstreamSol, @DrPhilCrosbie

  • Contributors Service concept: RB, PAJC, PVB and JT. Service development by members of the Macmillan Cancer Improvement Partnership: RB, PAJC, PVB, JT, DC, AM, PE, ST. Service operation and delivery by the Manchester University NHS Foundation Trust lung cancer team: HB, ME, JL, RB, PAJC and AS. Radiology reporting by the radiology consortium: RD, MG, JH, KI, DK, SM, TN, AS, ES, BT, AW and JW. Data collection, analysis and drafting of manuscript: MBL, HB, HAR and PAJC. Guarantor of overall content PAJC. Review, revision and agreement of final manuscript: all authors.

  • Funding The Manchester ‘Lung Health Check’ pilot was supported by funding from Macmillan Cancer Support and the Macmillan Cancer Improvement Partnership facilitated service design and development. PAJC is supported by the NIHR Manchester Biomedical Research Centre. MBL is supported by the NIHR Manchester Biomedical Research Centre. HAR is supported by the INTEGRAL project (USA National Cancer Institute U19 CA203654).

  • Disclaimer Where authors are identified as personnel of the International Agency for Research on Cancer/ World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. We have established a Lung Cancer Steering Committee who will consider applications for data access.

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