Assessing the impact of increasing lung screening eligibility by relaxing the maximum years-since-quit threshold. A simulation modeling study

R Meza*, PP Cao, K de Nijs, J Jeon, RA Smith, K ten Haaf, H de Koning

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)
52 Downloads (Pure)

Abstract

Background
In 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50–80 years who had ever smoked and had at least 20 pack-years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.

Methods
The authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life-years gained), and harms (false-positive tests, overdiagnosed cases, radiation-induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy.

Results
As the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms.

Conclusions
Expanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life-years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.
Original languageEnglish
Pages (from-to)244-255
Number of pages12
JournalCancer
Volume130
Issue number2
Early online date1 Nov 2023
DOIs
Publication statusPublished - 15 Jan 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

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