Model-Based Eligibility for Lung Cancer Screening: Where Theory Meets Practice
Authors: Angela K. Green, Peter Bach
Journal: Annals of Internal Medicine (2018)

Editorials6 February 2018Model-Based Eligibility for Lung Cancer Screening: Where Theory Meets PracticeAngela K. Green, MD, MSc and Peter Bach, MD, MAPPAngela K. Green, MD, MScMemorial Sloan Kettering Cancer Center, New York, New York (A.K.G., P.B.) and Peter Bach, MD, MAPPMemorial Sloan Kettering Cancer Center, New York, New York (A.K.G., P.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3316 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Although the NLST (National Lung Screening Trial) demonstrated that computed tomography (CT) screening for lung cancer is associated with a reduction in lung cancer deaths, it also showed that screening often detects noncancerous nodules that are the gateway to patients undergoing repeated imaging, biopsies, and unnecessary surgical resections. Postpublication analyses of the NLST data confirmed what Bach and colleagues (1) had predicted in simulation models, namely that lung cancer deaths within the cohort screened in the NLST would be heavily concentrated among persons whose lung cancer risk was particularly elevated. More refined risk stratification therefore might improve the risk–benefit tradeoff ...References1. Bach PB, Kattan MW, Thornquist MD, Kris MG, Tate RC, Barnett MJ, et al. Variations in lung cancer risk among smokers. J Natl Cancer Inst. 2003;95:470-8. [PMID: 12644540] CrossrefMedlineGoogle Scholar2. Tammemägi MC, Katki HA, Hocking WG, Church TR, Caporaso N, Kvale PA, et al. Selection criteria for lung-cancer screening. N Engl J Med. 2013;368:728-36. [PMID: 23425165] doi:10.1056/NEJMoa1211776 CrossrefMedlineGoogle Scholar3. Katki HA, Kovalchik SA, Berg CD, Cheung LC, Chaturvedi AK. Development and validation of risk models to select ever-smokers for ct lung cancer screening. JAMA. 2016;315:2300-11. [PMID: 27179989] doi:10.1001/jama.2016.6255 CrossrefMedlineGoogle Scholar4. Bach PB, Gould MK. When the average applies to no one: personalized decision making about potential benefits of lung cancer screening. Ann Intern Med. 2012;157:571-3. [PMID: 22893040] LinkGoogle Scholar5. Ten Haaf K, Jeon J, Tammemägi MC, Han SS, Kong CY, Plevritis SK, et al. Risk prediction models for selection of lung cancer screening candidates: A retrospective validation study. PLoS Med. 2017;14:e1002277. [PMID: 28376113] doi:10.1371/journal.pmed.1002277 CrossrefMedlineGoogle Scholar6. Cheung LC, Katki HA, Chaturvedi AK, Jemal A, Berg CD. Preventing lung cancer mortality by computed tomography screening: the effect of risk-based versus U.S. Preventive Services Task Force eligibility criteria, 2005–2015. Ann Intern Med. 2018;168:229-32. doi:10.7326/M17-2067 LinkGoogle Scholar7. Kumar V, Cohen JT, van Klaveren D, Soeteman DI, Wong JB, Neumann PJ, et al. Risk-targeted lung cancer screening. A cost-effectiveness analysis. Ann Intern Med. 2018;168:161-9. doi:10.7326/M17-1401 LinkGoogle Scholar8. Jemal A, Fedewa SA. Lung cancer screening with low-dose computed tomography in the United States—2010 to 2015. JAMA Oncol. 2017;3:1278-1281. [PMID: 28152136] doi:10.1001/jamaoncol.2016.6416 CrossrefMedlineGoogle Scholar9. U.S. Preventive Services Task Force. Final Recommendation Statement. Lung Cancer: Screening. December 2016. Accessed at www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening on 12 December 2017. Google Scholar10. Centers for Medicare & Medicaid Services. Voting questions. Accessed at www.cms.gov/Regulations-and-Guidance/Guidance/FACA/Downloads/id68b.pdf on 12 December 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: Memorial Sloan Kettering Cancer Center, New York, New York (A.K.G., P.B.)Note: Research for this article is based in part on health care charge data compiled and maintained by FAIR Health.Disclaimer: The authors are solely responsible for the research and conclusions reflected in this article. FAIR Health is not responsible for the conduct of the research or for any of the opinions expressed in this article.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3316.Corresponding Author: Angela K. Green, MD, MSc, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; e-mail, [email protected]org.Current Author Addresses: Dr. Green: Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.Dr. Bach: Memorial Sloan Kettering, 485 Lexington Avenue, New York, NY 10017.This article was published at Annals.org on 2 January 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRisk-Targeted Lung Cancer Screening Vaibhav Kumar , Joshua T. Cohen , David van Klaveren , Djøra I. Soeteman , John B. Wong , Peter J. Neumann , and David M. Kent Preventing Lung Cancer Mortality by Computed Tomography Screening: The Effect of Risk-Based Versus U.S. Preventive Services Task Force Eligibility Criteria, 2005–2015 Li C. Cheung , Hormuzd A. Katki , Anil K. Chaturvedi , Ahmedin Jemal , and Christine D. Berg Metrics Cited byComparative Modeling to Inform Health Policy Decisions: A Step ForwardDavid D. Kim, PhD and Peter J. Neumann, ScDIdentification of Candidates for Longer Lung Cancer Screening Intervals Following a Negative Low-Dose Computed Tomography ResultThe potential impact of chronic obstructive pulmonary disease in lung cancer screening: implications for the screening clinicIn-person and Telephonic Shared Decision-making Visits for People Considering Lung Cancer ScreeningShared Decision-making and Lung Cancer ScreeningRebuttal From Dr WoodLung cancer screening based on personal risk may save more livesRisk targeting has no impact on CE of lung cancer screening 6 February 2018Volume 168, Issue 3Page: 223-224KeywordsCancer screeningComputed axial tomographyDisclosureHealth surveysLung and intrathoracic tumorsLung cancer screeningLungsMedicareQuality adjusted life yearsSurgical resection ePublished: 2 January 2018 Issue Published: 6 February 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...