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
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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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