Personalising lung cancer screening: An overview of risk-stratification opportunities and challenges

Kevin ten Haaf*, Carlijn M. van der Aalst, Harry J. de Koning, Rudolf Kaaks, Martin C. Tammemägi

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)

Abstract

Randomised clinical trials have shown the efficacy of computed tomography lung cancer screening, initiating discussions on whether and how to implement population-based screening programs. Due to smoking behaviour being the primary risk-factor for lung cancer and part of the criteria for determining screening eligibility, lung cancer screening is inherently risk-based. In fact, the selection of high-risk individuals has been shown to be essential in implementing lung cancer screening in a cost-effective manner. Furthermore, studies have shown that further risk-stratification may improve screening efficiency, allow personalisation of the screening interval and reduce health disparities. However, implementing risk-based lung cancer screening programs also requires overcoming a number of challenges. There are indications that risk-based approaches can negatively influence the trade-off between individual benefits and harms if not applied thoughtfully. Large-scale implementation of targeted, risk-based screening programs has been limited thus far. Consequently, questions remain on how to efficiently identify and invite high-risk individuals from the general population. Finally, while risk-based approaches may increase screening program efficiency, efficiency should be balanced with the overall impact of the screening program. In this review, we will address the opportunities and challenges in applying risk-stratification in different aspects of lung cancer screening programs, as well as the balance between screening program efficiency and impact.

Original languageEnglish
Pages (from-to)250-263
Number of pages14
JournalInternational Journal of Cancer
Volume149
Issue number2
DOIs
Publication statusPublished - 15 Jul 2021

Bibliographical note

Funding Information:
HJdK reports grants from Cancer Research UK, NIH/National Cancer Institute and University of Zurich, Switzerland, received speakers' fees for (a) a symposium at the University of Zurich, (b) a symposium sponsored by MSDTeva, (c) an online lecture for Menarini; received nonfinancial support from International Association for the Study of Lung Cancer and is reviewer of the IPSOS Mori Targeted Lung Health Checks NHS England, outside the submitted work.

Funding Information:
CMvdA reports nonfinancial support from International Association for the Study of Lung Cancer and grants from the NIH/National Cancer Institute, outside the submitted work.

Funding Information:
We thank the National Cancer Institute (NCI) for access to NCI's data collected by the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). KtH, CMvdA, HJdK and RK were funded by EU‐Horizon 2020 grant (4‐IN‐THE‐LUNG‐RUN; lung cancer screening implementation trial; grant number 848294). Additionally, KtH, CMvdA and HJdK were funded by CLEARLY‐TRANSCAN‐FP‐045. The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of this article.

Funding Information:
KtH reports grants from Cancer Research UK, NIH/National Cancer Institute and University of Zurich, Switzerland, nonfinancial support from International Association for the Study of Lung Cancer, nonfinancial support from Russian Society of Clinical Oncology, nonfinancial support and other from Biomedical Research in Endstage and Obstructive Lung Disease Hannover (Breath), outside the submitted work.

Funding Information:
We thank the National Cancer Institute (NCI) for access to NCI's data collected by the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). KtH, CMvdA, HJdK and RK were funded by EU-Horizon 2020 grant (4-IN-THE-LUNG-RUN; lung cancer screening implementation trial; grant number 848294). Additionally, KtH, CMvdA and HJdK were funded by CLEARLY-TRANSCAN-FP-045. The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of this article.

Publisher Copyright:
© 2021 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of Union for International Cancer Control.

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