Lung Cancer Screening Requires Effective Risk Stratification

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Patients in higher quintiles of lung cancer risk had significantly more lung cancers diagnosed.
Patients in higher quintiles of lung cancer risk had significantly more lung cancers diagnosed.

HealthDay News — Lung cancer screening is more effective and efficient in high-risk individuals, according to a research letter published in JAMA Internal Medicine.

Noting that the Veterans Health Affairs lung cancer screening demonstration project identified a much higher false-positive rate after initial low-dose computed tomographic screening than did the National Lung Screening Trial, Tanner J. Caverly, MD, MPH, from the VA Center for Clinical Management Research in Ann Arbor, Michigan, and colleagues examined how this rate influences the harm-to-benefit ratio for higher- vs lower-risk patients. A total of 2106 patients were screened from March 31, 2005, through June 30, 2015. Patients were categorized into risk quintiles and assessed for the number of lung cancer cases observed, screening effectiveness, and screening efficiency.

The researchers found that patients in higher quintiles of lung cancer risk had significantly more lung cancers diagnosed. Initial screens were least and most effective for veterans in quintile 1 (lowest risk) and 5 (highest risk), respectively. Across risk quintiles there was no significant difference in rates of false-positive results and downstream evaluations. The increasing absolute benefit vs relatively stable harms enhanced the favorable balance of harm to benefit for higher- vs lower-risk individuals. The initial screen was least and most efficient for patients in quintile 1 and 5, respectively.

"These real-world findings reinforce the need to risk-stratify patients for [lung cancer screening] and provide support for personalized, risk-based harm-benefit estimates for all eligible persons during [lung cancer screening] decision-making," the authors wrote.

Disclosure: One author disclosed financial ties to the pharmaceutical industry.

Reference

Caverky TJ, Fagerline A, Weiner RS, et al. Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project [published online January 22, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.8170

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