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Risk prediction model outperforms US screening criteria for lung cancer detection
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BARCELONA — The PLCOm2012 risk prediction model improved the detection of lung cancer compared with criteria that form the basis of the U.S. Preventive Services Task Force recommendations on lung cancer screening, according to results of a prospective trial presented during the presidential symposium of International Association for the Study of Lung Cancer World Conference on Lung Cancer.
“We know that screening with low-dose CT saves lives by reducing lung cancer mortality by at least 20%,” Stephen Lam, MD, professor of medicine at University of British Columbia in Vancouver, said during a press conference. “But lung cancer screening is quite different than other cancer screening; we do not screen everyone in a specific age group. The key issue in lung cancer screening is identifying people with sufficient risk who would benefit most from low-dose CT screening.”
That 20% reduction in lung cancer morality was the key finding of the National Lung Screening Trial. The USPSTF used these study results to recommend low-dose dose CT screening among high-risk adults aged 55 to 80 years with at least 30 pack-years and who smoked within the last 15 years.
PLCOm2012 — a risk prediction model that is favored by organizations in Europe, Canada and Australia — uses seven nonsmoking and four smoking predictors to determine who should undergo lung cancer screening. Based on this model, patients are recommended to undergo screening if they have a 6-year risk for lung cancer greater than 1.5%.
To compare these two models, Lam and colleagues conducted the multicenter International Lung Screening Trial, which enrolled 4,985 ever-smokers from nine centers who met either screening criteria. Patients underwent two annual screens and were followed for 6 years.
Of patients screened, 110 had lung cancer. Ninety-nine percent of these lung cancers were detected using PLCOm2012 criteria, compared with only 77% by USPSTF criteria.
Further, 21.8% of cancers were detected by PLCOm2012 alone, compared with only 0.9% by USPSTF criteria alone.
Researchers found that of the 18.2% of individuals who would not undergo screening per USPSTF guidelines, 80% of them had potentially curable stage I/stage II lung cancer. Conversely, only 0.3% of those not selected by the PLCOm2012 criteria had lung cancer.
Results also identified a 6-year risk of 1.7% per PLCOm2012 as the optimal threshold for screening. – by Alexandra Todak
Reference:
Lam S, et al. Abstract PL02.02. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Sept. 7-10, 2019; Barcelona.
Disclosures: Lam reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.