USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study.

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Lancet Oncol. 2022 Jan;23(1):138-148. doi: 10.1016/S1470-2045(21)00590-8. Epub 2021 Dec 11.

USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study.

The Lancet. Oncology

Martin C Tammemägi, Mamta Ruparel, Alain Tremblay, Renelle Myers, John Mayo, John Yee, Sukhinder Atkar-Khattra, Ren Yuan, Sonya Cressman, John English, Eric Bedard, Paul MacEachern, Paul Burrowes, Samantha L Quaife, Henry Marshall, Ian Yang, Rayleen Bowman, Linda Passmore, Annette McWilliams, Fraser Brims, Kuan Pin Lim, Lin Mo, Stephen Melsom, Bann Saffar, Mark Teh, Ramon Sheehan, Yijin Kuok, Renee Manser, Louis Irving, Daniel Steinfort, Mark McCusker, Diane Pascoe, Paul Fogarty, Emily Stone, David C L Lam, Ming-Yen Ng, Varut Vardhanabhuti, Christine D Berg, Rayjean J Hung, Samuel M Janes, Kwun Fong, Stephen Lam

Affiliations

Department of Health Sciences, Brock University, St Catharines, ON, Canada. Electronic address: [email protected].
Lungs for Living, UCL Respiratory, Department of Medicine, University College London, London, UK.
Division of Respiratory Medicine & Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Department of Radiology, Vancouver, BC, Canada.
Department of Thoracic Surgery, Vancouver, BC, Canada.
BC Cancer Research Centre, Integrative Oncology, Vancouver, BC, Canada.
Vancouver Coastal Health, Vancouver, BC, Canada; Department of Radiology, BC Cancer, Vancouver, BC, Canada.
Centre for Epidemiology and Evaluation, SFU, Burnaby, BC, Canada.
Department of Pathology, Vancouver, BC, Canada.
Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Department of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Diagnostic Imaging, Foothills Medical Center, Calgary, AB, Canada.
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia.
Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Curtin Medical School, National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Perth, WA, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Royal Darwin Hospital, Tiwi, NT, Australia.
Department of Medical Imaging, Fiona Stanley Hospital, Murdoch, WA, Australia.
Department of Medical Imaging, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia; Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
Department of Radiology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Epworth Internal Medicine Clinical Institute, Melbourne VIC, Australia.
St Vincent's Hospital, Kinghorn Cancer Centre, University of New South Wales, Sydney, NSW, Australia.
Department of Medicine, University of Hong Kong, Hong Kong.
Department of Diagnostic Radiology, University of Hong Kong, Hong Kong.
US National Cancer Institute, Rockville, MD, USA.
Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada.

PMID: 34902336 DOI: 10.1016/S1470-2045(21)00590-8

Abstract

BACKGROUND: Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria.

METHODS: In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete.

FINDINGS: Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015).

INTERPRETATION: PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes.

FUNDING: Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.

Conflict of interest statement

Declaration of interests MCT developed the PLCOm2012 lung cancer risk prediction models, which is used in this study. The model is open access and is available free of charge to non-commercial users.

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Journal Article