Highlights
- •Lung cancer risk increases with time in most patients ineligible for lung screening.
- •Subpopulations of ineligible patients have much faster increase in lung cancer risk.
- •Smoking status and duration, less education, and COPD predict future screening eligibility.
- •Predictive modeling using participants current behaviors can estimate future risk.
Abstract
This study identifies participants ineligible for lung cancer screening with the greatest
likelihood of future eligibility. Lung cancer risk in participants enrolled in longitudinal
lung screening was assessed using the Prostate, Lung, Colorectal and Ovarian lung
cancer risk calculator (PLCOm2012) at two timepoints: baseline (T1) and follow-up (T2). Separate analyses were performed on four PLCOm2012 eligibility thresholds (3.25%, 2.00%, 1.50%, and 1.00%); only participants with a
T1 risk less than the threshold were included in that analysis. Cox-models identified
T1 risk factors associated with screen-eligibility at T2. Three models, applying differing assumptions of participant behavior, predicted
future eligibility and were benchmarked against the observed cohort. Nine hundred
and fifty-six participants had a T1 risk <3.25%; at 2.00% n= 755; at 1.50% n= 652; at 1.00% n= 484. Lung cancer risk
increased over time in most screen-ineligible participants. However, risk increased
much faster in participants who became screen-eligible at T2 compared to those who remained screen-ineligible (median per-year increase of 0.35%
versus 0.02%, when using a 3.25% threshold). Participants smoking for >30 years, current
smokers, less educated participants, and those with chronic obstructive pulmonary
disease (COPD) at T1 were significantly more likely to become screen-eligible. New diagnoses of COPD and/or
non-lung cancers between T1 and T2 precipitated eligibility in a subset of participants. The prediction model that assumed
health behaviors observed at T1 continued to T2 reasonably predicted changes in lung cancer risk. This prediction model and the identified
baseline risk factors can identify screen-ineligible participants who should be closely
followed for future eligibility.
Keywords
Abbreviations:
NLST (National Lung Screening Trial), NELSON (Dutch-Belgian Lung Cancer Screening Trial), Low-dose Computed Tomography (LDCT), PLCOm2012 (Prostate, Lung, Colorectal and Ovarian Six-year Lung Cancer Risk Calculator), ILST (International Lung Screen Trial), OLSP (Ontario Lung Screening Program), PMLSP (Princess Margaret Lung Screening Program), FHS (Framingham Heart Study)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 20, 2021
Accepted:
September 5,
2021
Received in revised form:
August 26,
2021
Received:
April 8,
2021
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
