Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts

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Background:
Lung cancer risks at which individuals should be screened with computed tomography (CT) for lung cancer are undecided. This study's objectives are to identify a risk threshold for selecting individuals for screening, to compare its efficiency with the U.S. Preventive Services Task Force (USPSTF) criteria for identifying screenees, and to determine whether never-smokers should be screened. Lung cancer risks are compared between smokers aged 55–64 and ≥65–80 y.

Methods and Findings:
Applying the PLCO_m2012 model, a model based on 6-y lung cancer incidence, we identified the risk threshold above which National Lung Screening Trial (NLST, n = 53,452) CT arm lung cancer mortality rates were consistently lower than rates in the chest X-ray (CXR) arm. We evaluated the USPSTF and PLCO_m2012 risk criteria in intervention arm (CXR) smokers (n = 37,327) of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The numbers of smokers selected for screening, and the sensitivities, specificities, and positive predictive values (PPVs) for identifying lung cancers were assessed. A modified model (PLCO_all2014) evaluated risks in never-smokers. At PLCO_m2012 risk ≥0.0151, the 65th percentile of risk, the NLST CT arm mortality rates are consistently below the CXR arm's rates. The number needed to screen to prevent one lung cancer death in the 65th to 100th percentile risk group is 255 (95% CI 143 to 1,184), and in the 30th to <65th percentile risk group is 963 (95% CI 291 to −754); the number needed to screen could not be estimated in the <30th percentile risk group because of absence of lung cancer deaths. When applied to PLCO intervention arm smokers, compared to the USPSTF criteria, the PLCO_m2012 risk ≥0.0151 threshold selected 8.8% fewer individuals for screening (p<0.001) but identified 12.4% more lung cancers (sensitivity 80.1% [95% CI 76.8%–83.0%] versus 71.2% [95% CI 67.6%–74.6%], p<0.001), had fewer false-positives (specificity 66.2% [95% CI 65.7%–66.7%] versus 62.7% [95% CI 62.2%–63.1%], p<0.001), and had higher PPV (4.2% [95% CI 3.9%–4.6%] versus 3.4% [95% CI 3.1%–3.7%], p<0.001). In total, 26% of individuals selected for screening based on USPSTF criteria had risks below the threshold PLCO_m2012 risk ≥0.0151. Of PLCO former smokers with quit time >15 y, 8.5% had PLCO_m2012 risk ≥0.0151. None of 65,711 PLCO never-smokers had PLCO_m2012 risk ≥0.0151. Risks and lung cancers were significantly greater in PLCO smokers aged ≥65–80 y than in those aged 55–64 y. This study omitted cost-effectiveness analysis.

Conclusions:
The USPSTF criteria for CT screening include some low-risk individuals and exclude some high-risk individuals. Use of the PLCO_m2012 risk ≥0.0151 criterion can improve screening efficiency. Currently, never-smokers should not be screened. Smokers aged ≥65–80 y are a high-risk group who may benefit from screening.

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Vyšlo v časopise: Evaluation of the Lung Cancer Risks at Which to Screen Ever- and Never-Smokers: Screening Rules Applied to the PLCO and NLST Cohorts. PLoS Med 11(12): e32767. doi:10.1371/journal.pmed.1001764
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001764

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Zdroje

1. AberleDR, AdamsAM, BergCD, BlackWC, ClappJD, et al. (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365: 395–409.

2. BachPB, MirkinJN, OliverTK, AzzoliCG, BerryDA, et al. (2012) Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 307: 2418–2429 doi:10.1001/jama.2012.5521

3. JaklitschMT, JacobsonFL, AustinJH, FieldJK, JettJR, et al. (2012) The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 144: 33–38.

4. WoodDE, EapenGA, EttingerDS, HouL, JackmanD, et al. (2012) Lung cancer screening. J Natl Compr Canc Netw 10: 240–265.

5. WenderR, FonthamET, BarreraEJr, ColditzGA, ChurchTR, et al. (2013) American Cancer Society lung cancer screening guidelines. CA Cancer J Clin 63: 106–117.

6. CouraudS, CortotAB, GreillierL, GounantV, MennecierB, et al. (2013) From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French Intergroup (IFCT) and the Groupe d'Oncologie de Langue Francaise (GOLF). Ann Oncol 24: 586–597.

7. RobertsH, Walker-DilksC, SivjeeK, UngY, YasufukuK, et al. (2013) Screening high-risk populations for lung cancer—guideline recommendations. J Thorac Oncol 8: 1232–1237.

8. BoisellePM, WhiteCS, RavenelJG (2013) Computed tomographic screening for lung cancer: current practice patterns at leading academic medical centers. JAMA Intern Med 174: 286–287 doi:10.1001/jamainternmed.2013.12693

9. MoyerVA (2013) U.S. Preventive Services Task Force (2013) Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 160: 330–338 doi:10.7326/M13-2771

10. de KoningHJ, MezaR, PlevritisSK, Ten HaafK, MunshiVN, et al. (2013) Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med 160: 311–320 doi:10.7326/M13-2316

11. TammemägiMC, KatkiHA, HockingWG, ChurchTR, CaporasoN, et al. (2013) Selection criteria for lung-cancer screening. N Engl J Med 368: 728–736.

12. KovalchikSA, TammemagiM, BergCD, CaporasoNE, RileyTL, et al. (2013) Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med 369: 245–254.

13. SametJM, Avila-TangE, BoffettaP, HannanLM, Olivo-MarstonS, et al. (2009) Lung cancer in never smokers: clinical epidemiology and environmental risk factors. Clin Cancer Res 15: 5626–5645.

14. ThunMJ, HannanLM, Adams-CampbellLL, BoffettaP, BuringJE, et al. (2008) Lung cancer occurrence in never-smokers: an analysis of 13 cohorts and 22 cancer registry studies. PLoS Med 5: e185.

15. SilvestriGA, NietertPJ, ZollerJ, CarterC, BradfordD (2007) Attitudes towards screening for lung cancer among smokers and their non-smoking counterparts. Thorax 62: 126–130.

16. Centers for Medicare & Medicaid Services (2014) MEDCAC Meeting 4/30/2014—lung cancer screening with low dose computed tomography. Available: http://www.cms.gov/medicare-coverage-database/details/medcac-meeting-details.aspx?MEDCACId=68&bc=AAAIAAAAAAAAAA%3d%3d&. Accessed 25 July 2014.

17. ProrokPC, AndrioleGL, BresalierRS, BuysSS, ChiaD, et al. (2000) Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials 21: 273S–309S.

18. OkenMM, MarcusPM, HuP, BeckTM, HockingW, et al. (2005) Baseline chest radiograph for lung cancer detection in the randomized Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. J Natl Cancer Inst 97: 1832–1839.

19. OkenMM, HockingWG, KvalePA, AndrioleGL, BuysSS, et al. (2011) Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA 306: 1865–1873.

20. AberleDR, BergCD, BlackWC, ChurchTR, FagerstromRM, et al. (2011) The National Lung Screening Trial: overview and study design. Radiology 258: 243–253.

21. AberleDR, AdamsAM, BergCD, ClappJD, ClinganKL, et al. (2010) Baseline characteristics of participants in the randomized national lung screening trial. J Natl Cancer Inst 102: 1771–1779.

22. Silverman BW (1998) Density estimation for statistics and data analysis. Boca Raton (Florida): Chapman & Hall/CRC. 175 p.

23. Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer. 568 p.

24. Harrell FE (2014) Regression modeling strategies: rms package—version 4.2-0 (manual date 2 July 2014, package date 13 April 2014). Vienna: R Foundation for Statistical Computing.

25. CoxDR (1958) Two further applications of a model for binary regression. Biometrika 45: 562–565.

26. Woodward M (2014) Epidemiology: study design and data analysis, 3rd edition. Boca Raton (Florida): CRC Press. 832 p.

27. PepeMS, LongtonG, JanesH (2009) Estimation and comparison of receiver operating characteristic curves. Stata J 9: 1–16.

28. ConnorRJ (1987) Sample size for testing differences in proportions for the paired-sample design. Biometrics 43: 207–211.

29. BrownLD, CaiTT, DasGuptaA (2001) Interval estimation for a binomial proportion. Stat Sci 16: 101–133.

30. MiettinenO (1976) Estimability and estimation in case-referent studies. Am J Epidemiol 103: 226–235.

31. CuzickJ (1985) A Wilcoxon-type test for trend. Stat Med 4: 87–90.

32. BenderR (2001) Calculating confidence intervals for the number needed to treat. Control Clin Trials 22: 102–110.

33. BachPB, GouldMK (2012) When the average applies to no one: personalized decision making about potential benefits of lung cancer screening. Ann Intern Med 157: 571–573.

34. HenleyJS, RichardsTB, UnderwoodMJ, SunderamCR, PlesciaM, et al. (2014) Lung cancer incidence trends among men and women—United States, 2005-2009. MMWR Morb Mortal Wkly Rep 63: 1–5.

35. CassidyA, MylesJP, van TongerenM, PageRD, LiloglouT, et al. (2008) The LLP risk model: an individual risk prediction model for lung cancer. Br J Cancer 98: 270–276.

36. RajiOY, DuffySW, AgbajeOF, BakerSG, ChristianiDC, et al. (2012) Predictive accuracy of the Liverpool Lung Project risk model for stratifying patients for computed tomography screening for lung cancer: a case-control and cohort validation study. Ann Intern Med 157: 242–250.

37. FordME, HavstadSL, FlickingerL, JohnsonCC (2003) Examining the effects of false positive lung cancer screening results on subsequent lung cancer screening adherence. Cancer Epidemiol Biomarkers Prev 12: 28–33.

38. MontesU, SeijoLM, CampoA, AlcaideAB, BastarrikaG, et al. (2007) Factors determining early adherence to a lung cancer screening protocol. Eur Respir J 30: 532–537.

39. OvhedI, OdebergH, RastamL (1993) Opportunistic screening for hypercholesterolaemia: characterization of two different drop-out groups and status after 2 years. Fam Pract 10: 439–443.

40. GroeneveldIF, ProperKI, van der BeekAJ, HildebrandtVH, van MechelenW (2009) Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Act 6: 80.

41. McWilliamsA, TammemagiMC, MayoJR, RobertsH, LiuG, et al. (2013) Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 369: 910–919.