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Management of Lung Cancer Screening Results Based on Individual Prediction of Current and Future Lung Cancer Risks
- Source :
- J Thorac Oncol
- Publication Year :
- 2022
- Publisher :
- Elsevier BV, 2022.
-
Abstract
- Objectives We propose a risk-tailored approach for management of lung cancer screening results. This approach incorporates individual risk factors and low-dose computed tomography (LDCT) image features into calculations of immediate and next-screen (1-y) risks of lung cancer detection, which in turn can recommend short-interval imaging or 1-year or 2-year screening intervals. Methods We first extended the "LCRAT+CT" individualized risk calculator to predict lung cancer risk after either a negative or abnormal LDCT screen result. To develop the abnormal screen portion, we analyzed 18,129 abnormal LDCT results in the National Lung Screening Trial (NLST), including lung cancers detected immediately (n = 649) or at the next screen (n = 235). We estimated the potential impact of this approach among NLST participants with any screen result (negative or abnormal). Results Applying the draft National Health Service (NHS) England protocol for lung screening to NLST participants referred 76% of participants to a 2-year interval, but delayed diagnosis for 40% of detectable cancers. The Lung Cancer Risk Assessment Tool+Computed Tomography (LCRAT+CT) risk model, with a threshold of less than 0.95% cumulative lung cancer risk, would also refer 76% of participants to a 2-year interval, but would delay diagnosis for only 30% of cancers, a 25% reduction versus the NHS protocol. Alternatively, LCRAT+CT, with a threshold of less than 1.7% cumulative lung cancer risk, would also delay diagnosis for 40% of cancers, but would refer 85% of participants for a 2-year interval, a 38% further reduction in the number of required 1-year screens beyond the NHS protocol. Conclusions Using individualized risk models to determine management in lung cancer screening could substantially reduce the number of screens or increase early detection.
- Subjects :
- Pulmonary and Respiratory Medicine
Oncology
medicine.medical_specialty
Potential impact
Lung Neoplasms
Lung
business.industry
Early detection
Risk management tools
medicine.disease
Precision medicine
Article
State Medicine
medicine.anatomical_structure
Internal medicine
medicine
Humans
Mass Screening
National Lung Screening Trial
Tomography, X-Ray Computed
Lung cancer
business
Early Detection of Cancer
Lung cancer screening
Subjects
Details
- ISSN :
- 15560864
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Journal of Thoracic Oncology
- Accession number :
- edsair.doi.dedup.....6c16596c699148ec37c0cb19503bab98