Risk-Based Lung Cancer Screening May Save More Lives Without Being Cost-Effective
By Reuters Staff
NEW YORK (Reuters Health) - Lung cancer screening based on individual risk may save more lives than current recommendations by the U.S. Preventive Services Task Force (USPSTF), but is less efficient in terms of cost and quality of life-years gained, according two reports in the Annals of Internal Medicine, online January 1.
The USPSTF recommends annual lung cancer screening using low-dose computed tomography for adults ages 55 to 80 who are current smokers or who have quit within the past 15 years after at least a 30-pack-year history of cigarette smoking.
“However, these criteria may exclude smokers at high risk for lung cancer who would have been selected for CT screening by individual risk calculators that more specifically account for demographic, clinical, and smoking characteristics,” Dr. Li C. Cheung from the National Cancer Institute in Bethesda, Maryland, and colleagues note in their article.
They compared USPSTF eligibility criteria with individualized, risk-based eligibility and estimated the effect of eligibility on lung cancer deaths preventable by screening since 2005. Data came from the 2005, 2010, and 2015 National Health Interview Survey for more than 17,000 ever-smokers ages 50 to 80.
Because the population’s smoking habits evolved from 2010 to 2015, adhering to the USPSTF criteria led to fewer ever-smokers being eligible for CT screening and fewer lung cancer deaths averted by screening, the researchers note. Using individual risk-based criteria would draw in high-risk moderate smokers who are currently not eligible for screening according to the USPSTF criteria. Using this approach (rather than the USPSTF criteria) could have prevented over 5,000 more lung cancer deaths in 2015, Dr. Cheung and colleagues calculate.
In a separate article, Dr. David Kent and colleagues from Tufts Medical Center in Boston present results of a cost-effectiveness analysis of risk-targeted lung cancer screening.
They report that risk-targeted screening may improve screening efficiency by reducing lung cancer mortality rates per individual screened. However, this targeted strategy does not offer noteworthy gains in terms of life-years saved, quality-adjusted life-years, and cost-effectiveness.
In a related editorial, Dr. Angela Green and Dr. Peter Bach from Memorial Sloan Kettering Cancer Center in New York say these analyses “leave little doubt that risk models might increase the efficiency of lung cancer screening. These models would have downsides - for example, they require calculations (several are online). However, for now, determining exactly who should be screened may only be academic, because screening rates are low.”
“The anemic pace at which lung cancer screening is being adopted is difficult to explain, especially because 4 years have passed since the USPSTF and many professional societies published guidelines favorable to the approach. Perhaps providers and patients remain skeptical of the value of low-dose CT screening,” the editorialists write.
“Although risk-based identification of persons who should be offered screening 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,” they conclude.
SOURCES: http://bit.ly/2DPseG7, http://bit.ly/2CrSPMp and http://bit.ly/2DQwRzO
Ann Intern Med 2018.
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