Risk-based CT screening may reduce deaths from lung cancer

January 1, 2018, American College of Physicians

Compared to National Lung Screening Trial criteria, targeting screening those at highest risk from lung cancer mortality using a risk prediction tool may improve efficiency in terms of greater reduction in mortality from lung cancer in the short term per person screened. However, such a targeted approach does not offer substantial gains in terms of life-years saved, quality-adjusted life-years (QALYs), and cost-effectiveness. The findings are published in Annals of Internal Medicine.

Most current lung cancers screening guidelines, including those from the U.S. Preventive Services Task Force (USPSTF), use screening criteria based on findings from the National Lung Screening Trial. Therefore, screening is recommended for persons between the ages of 55 and 74 years with a smoking history of at least 30 pack-years and former smokers who had no more than 15 years of smoking abstinence. However, targeting low-dose computed tomography (LDCT) for screening to persons at highest risk for lung cancer mortality has been suggested as a way to improve screening efficiency.

Researchers from Tufts Medical Center compared the cost-effectiveness of a risk-targeted screening strategy to that of using National Lung Screening trial (NLST) criteria by estimating the quality-adjusted life-years (QALYs) gained relative to the cost of screening with each of these strategies. While high risk patients were more likely to have lung cancer detected, and targeted screening was more likely to avert lung cancer death over the seven years of the trial, those at higher risk were also older, had greater smoking exposure, and were more likely to have a preexisting diagnosis of chronic obstructive pulmonary disease. These patients have a shorter life expectancy and a lower quality of life; this means that preventing a death in a higher-risk individual translates to fewer QALYs than preventing a death in someone at a lower risk. Moreover, LDCT screening high risk patients is also more costly because it leads to more invasive testing. Thus, applying such a risk model to target screening is unlikely to lead to substantial improvement in the cost-effectiveness of LDCT screening in terms of QALYs gained compared to the NLST criteria.

The authors of a related editorial from Memorial Sloan Kettering Cancer Center write that cancer is still one of the most deadly types of in the U.S. and LDCT screening offers a potentially effective means to improve on that fact. Although risk-based identification of persons who should be offered is empirically superior to using the current cutoffs, the more pressing concern is why people, regardless of how their eligibility is defined, are not receiving the test.

Explore further: Lung cancer screening found cost-effective for Medicare

More information: Study: http://annals.org/aim/article/doi/10.7326/M17-1401

Editorial: http://annals.org/aim/article/doi/10.7326/M17-3316

Related Stories

Lung cancer screening found cost-effective for Medicare

October 3, 2014
(HealthDay)—Low-dose computed tomography (LDCT) is a low-cost and cost-effective strategy for screening Medicare beneficiaries for lung cancer, according to a study published in the August issue of American Health & Drug ...

Less inclusive criteria for lung cancer screening would be cost-effective

February 7, 2017
Limiting lung cancer screening to high-risk former smokers may improve cost-effectiveness at a population level, according to a study published in PLOS Medicine. Regular computed tomography (CT) lung cancer screening of current ...

Risks of LDCT LC screenings need to be assessed in 20- to 29-pack-year smokers

October 19, 2015
The potential risks and harms of low-dose CT (LDCT) lung cancer screening in current 20- to 29-pack-year smokers needs to be assessed before recommending LDCT to this group, according to a study published October 19 in the ...

Integration of smoking cessation within CT lung cancer screenings shows life-saving results

October 16, 2017
A study that integrated robust smoking cessation programs into an organized low-dose CT (LDCT) lung cancer screening program found that the inclusion of both interventions has the potential to decrease mortality rates while ...

Canadian group gives guideline recommendations for lung cancer screening

September 4, 2013
Lung cancer is the most common cause of cancer death in Ontario. Screening for lung cancer using low-dose computed tomography (LDCT) has been the subject of many research studies since the 1990s. The National Lung Screening ...

Smokers who receive CT lung screening are more likely to quit

July 24, 2017
Smokers who undergo a CT scan of their lungs are more likely to quit than those who don't, concludes a trial led by Cardiff University.

Recommended for you

Removing the enablers: Reducing number of tumor-supporting cells to fight neuroblastoma

April 24, 2018
Investigators at the Children's Center for Cancer and Blood Diseases at Children's Hospital Los Angeles provide preclinical evidence that the presence of tumor-associated macrophages—a type of immune cell—can negatively ...

Technology used to map Mars now measuring effect of treatment on tumours

April 24, 2018
A machine learning approach for assessing images of the craters and dunes of Mars, which was developed at The University of Manchester, has now been adapted to help scientists measure the effects of treatments on tumours.

New test could tell doctors whether patients will respond to chemotherapy

April 24, 2018
Less than half the patients diagnosed with cancer respond favorably to chemotherapy, but a new method for testing how patients will respond to various drugs could pave the way for more personalized treatment.

Scientists create better laboratory tools to study cancer's spread

April 23, 2018
Cancer that has spread, or metastasized, from its original site to other tissues and organs in the body is a leading cause of cancer death. Unfortunately, research focused on metastatic disease has been limited by a lack ...

The role of 'extra' DNA in cancer evolution and therapy resistance

April 23, 2018
Glioblastoma (GBM) is the most common and aggressive form of brain cancer. Response to standard-of-care treatment is poor, with a two-year survival rate of only 15 percent. Research is beginning to provide a better understanding ...

Size, structure help poziotinib pose threat to deadly exon 20 lung cancer

April 23, 2018
A drug that failed to effectively strike larger targets in lung cancer hits a bulls-eye on the smaller target presented by a previously untreatable form of the disease, researchers at The University of Texas MD Anderson Cancer ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.