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

Pubmed ID: 25652107

Pubmed Central ID: PMC4492436

Journal: Cancer

Publication Date: May 15, 2015

Affiliation: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts.

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, United States, Middle Aged, Smoking, Life Expectancy, Prevalence, Risk Assessment, Computer Simulation, Mass Screening, Pulmonary Disease, Chronic Obstructive, Spirometry, Decision Support Techniques, Lung Neoplasms, Tomography, X-Ray Computed, Early Detection of Cancer, Pulmonary Ventilation, Precision Medicine

Grants: R00 CA126147, R01 CA097337, R01 DA036497, U01 CA152956, K25 CA133141, R01 CA97337, U01CA152956

Authors: Lowry KP, Gazelle GS, Gilmore ME, Johanson C, Munshi V, Choi SE, Tramontano AC, Kong CY, McMahon PM

Cite As: Lowry KP, Gazelle GS, Gilmore ME, Johanson C, Munshi V, Choi SE, Tramontano AC, Kong CY, McMahon PM. Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis. Cancer 2015 May 15;121(10):1556-62. Epub 2015 Feb 3.

Studies:

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.