Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis.

View Abstract

BACKGROUND

Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.

METHODS

We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.

RESULTS

Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.

CONCLUSIONS

Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population.

Investigators
Abbreviation
Cancer
Publication Date
2015-02-03
Volume
121
Issue
10
Page Numbers
1556-62
Pubmed ID
25652107
Medium
Print-Electronic
Full Title
Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis.
Authors
Lowry KP, Gazelle GS, Gilmore ME, Johanson C, Munshi V, Choi SE, Tramontano AC, Kong CY, McMahon PM