Using Risk Models to Make Lung Cancer Screening Decisions: Evidence-Based and Getting Better
Authors: Tanner J. Caverly, Rafael Meza
Journal: Annals of Internal Medicine (2019)

Editorials5 November 2019Using Risk Models to Make Lung Cancer Screening Decisions: Evidence-Based and Getting BetterTanner J. Caverly, MD, MPH and Rafael Meza, PhDTanner J. Caverly, MD, MPHVA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan (T.J.C.)Search for more papers by this author and Rafael Meza, PhDUniversity of Michigan, Ann Arbor, Michigan (R.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-2869 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Two smokers are considering lung cancer screening with low-dose computed tomography (CT): Mr. Ryan, a 72-year-old man with several comorbidities, and Mrs. King, a 55-year-old woman who is otherwise healthy. Are these very different patients good screening candidates? How can we estimate their potential benefit from CT screening? How should we approach the question? The study by Cheung and colleagues provides one clear answer while adding a new wrinkle (1).Deciding who should undergo screening involves a tradeoff between accuracy (how well does the strategy identify good screening candidates?) and complexity (how hard is it to implement the strategy in ...References1. Cheung LC, Berg CD, Castle PE, et al. Life-gained–based versus risk-based selection of smokers for lung cancer screening. Ann Intern Med. 2019;171:623-32. doi:10.7326/M19-1263 LinkGoogle Scholar2. Moyer VA; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330-8. [PMID: 24378917]. doi:10.7326/M13-2771 LinkGoogle Scholar3. Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. [PMID: 21714641] doi:10.1056/NEJMoa1102873 CrossrefMedlineGoogle Scholar4. Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. 2013;369:245-54. [PMID: 23863051] doi:10.1056/NEJMoa1301851 CrossrefMedlineGoogle Scholar5. Tammemägi MC, Church TR, Hocking WG, et al. 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. 2014;11:e1001764. [PMID: 25460915] doi:10.1371/journal.pmed.1001764 CrossrefMedlineGoogle Scholar6. Kent DM, Nelson J, Dahabreh IJ, et al. Risk and treatment effect heterogeneity: re-analysis of individual participant data from 32 large clinical trials. Int J Epidemiol. 2016;45:2075-88. [PMID: 27375287] doi:10.1093/ije/dyw118 CrossrefMedlineGoogle Scholar7. Ten Haaf K, Jeon J, Tammemägi MC, 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 Scholar8. Caverly TJ, Cao P, Hayward RA, et al. Identifying patients for whom lung cancer screening is preference-sensitive: a microsimulation study. Ann Intern Med. 2018;169:1-9. [PMID: 29809244]. doi:10.7326/M17-2561 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan (T.J.C.)University of Michigan, Ann Arbor, Michigan (R.M.)Acknowledgment: The authors thank Rodney Hayward and Jeremy Sussman for reviewing the ideas in this manuscript.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-2869.Corresponding Author: Tanner J. Caverly, MD, MPH, VA Center for Clinical Management Research and University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 331, Ann Arbor, MI 48109-2800; e-mail, [email protected]umich.edu.Current Author Addresses: Dr. Caverly: VA Center for Clinical Management Research and University of Michigan Medical School, 2800 Plymouth Road, Building 16, Room 331, Ann Arbor, MI 48109-2800.Dr. Meza: Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029.This article was published at Annals.org on 22 October 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLife-Gained–Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening Li C. Cheung , Christine D. Berg , Philip E. Castle , Hormuzd A. Katki , and Anil K. Chaturvedi Metrics Cited byUnstructured Data Are Superior to Structured Data for Eliciting Quantitative Smoking History From the Electronic Health RecordLung cancer screening at the VA: Past, present and futureImplementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement EvaluationA risk‐based framework for assessing real‐time lung cancer screening eligibility that incorporates life expectancy and past screening findingsExamining lung cancer screening utilization with public-use data: Opportunities and challengesA more effective approach to lung cancer screening? 5 November 2019Volume 171, Issue 9Page: 669-670KeywordsCancer screeningComputed axial tomographyDisclosureElectronic medical recordsForecastingLife expectancyLung and intrathoracic tumorsLung cancer screeningRandomized trialsRelative risk ePublished: 22 October 2019 Issue Published: 5 November 2019 PDF downloadLoading ...