Researchers at the University of Michigan in Ann Arbor have developed a new way to select individuals to be screened for lung cancer that could prevent 14 percent of lung cancer deaths per year.
The method considers individuals’ probability of getting or dying from lung cancer calculated from risk-prediction models.
The Cancer Intervention and Surveillance Modeling Network Lung Working Group, which includes researchers from the U-M School of Public Health, says this means nearly 2,000 deaths could be prevented each year in the U.S. by factoring in information from risk-prediction models developed in recent years that considers people’s risk factor profiles.
“It is important that recommendations on lung cancer screening not only take into account the risk for developing lung cancer, but also the overall health and life expectancy of the individual,” says Kevin ten Haaf of Erasmus MC, University Medical Center in Rotterdam, Netherlands. “Doing so will further help to identify those for whom screening is most beneficial and reduce the potential harms of screening.”
Current lung cancer screening is based on age, how much individuals have smoked, and how long since they have stopped smoking. The team looked at various risk-prediction models that consider behavior, lifestyle, and family history to estimate the probability of getting or dying from lung cancer.
While a more precise risk calculation resulted in lives saved, improvements in the number of years gained were more modest. Researchers say this has to do with the fact that cancer risk increases with age, so individuals with high risk tend to be older when life expectancy is already lower. Current recommendations based on time smoking and time since quitting favor screening among younger individuals.
“The results of this study are of major importance for the implementation of lung cancer screening worldwide,” says Rafael Meza, associate chair of epidemiology at the U-M School of Public Health and coordinating principal investigator of the group.
“Risk-based screening strategies have the potential of saving more lives. However, by moving screening to older ages, they result in fewer years of life saved per lung cancer death prevented. This is important for countries to consider, as well as the challenges of implementing risk calculation in clinical settings, when deciding which strategy works best for them.”
In addition, older individuals with an increased risk for lung cancer are more likely to be subject to potential harms of screening, such as overdiagnosis, Meza says.
The group published its findings in the Journal of the National Cancer Institute. The full report is available here.