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

Cancer. 2015 May 15;121(10):1556-62. doi: 10.1002/cncr.29225. Epub 2015 Feb 3.

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.

Keywords: cancer screening; chronic obstructive pulmonary disease; decision analysis; lung neoplasms.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Computer Simulation / statistics & numerical data*
  • Decision Support Techniques*
  • Early Detection of Cancer* / methods
  • Early Detection of Cancer* / standards
  • Early Detection of Cancer* / trends
  • Female
  • Humans
  • Life Expectancy
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / prevention & control
  • Male
  • Mass Screening* / methods
  • Mass Screening* / standards
  • Mass Screening* / trends
  • Middle Aged
  • Precision Medicine* / methods
  • Precision Medicine* / standards
  • Precision Medicine* / trends
  • Prevalence
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Ventilation
  • Risk Assessment
  • Risk Factors
  • Smoking / adverse effects*
  • Spirometry
  • Tomography, X-Ray Computed
  • United States / epidemiology