Li C. Cheung, PhD Staff Scientist, Biostatistics Branch Division of Cancer Epidemiology & Genetics NCI National Cancer Institute

Lung Cancer Screening: Using Life-Gained Model To Reduce Harms and Prevent More Deaths

MedicalResearch.com Interview with:

Li C. Cheung, PhD Staff Scientist, Biostatistics Branch Division of Cancer Epidemiology & Genetics NCI National Cancer Institute

Dr. Cheung

Li C. Cheung, PhD
Staff Scientist, Biostatistics Branch
Division of Cancer Epidemiology & Genetics
NCI National Cancer Institute

MedicalResearch.com: What is the background for this study?

Response: Using individualized risk prediction models to select individuals for lung-cancer screening will prevent more lung cancer deaths than current USPSTF guidelines (ages 55-80y; 30+ pack-years; smoke in past 15y). However, risk-based screening would lead to screening even more older smokers with comorbidities, for whom the harms of screening may outweigh the benefits.

MedicalResearch.com: What are the main findings? 

Response: We developed a calculator for individualized life-years gained from screening.  We found that life-gained-based screening is also an improvement over current USPSTF guidelines. This method prevents more lung cancer deaths and increases life-expectancy to a greater extent than risk-based models. In addition, life-gained-based screening may result in fewer screening harms (e.g. surgical complications) compared to risk-based screening. 

MedicalResearch.com: What should readers take away from your report? 

Response: Using individualized life-years gained from screening is an attractive alternative to individualized risk models because it accounts for a patient’s life-expectancy, and thus their overall health, and improves their likelihood of benefiting from screening.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Research is needed on how to incorporate individualized life-gained into shared decision-making to help physicians and patients make decisions about whether to undergo lung cancer screening.  Our model can help answer the question “How many years of life would I gain from screening?” Before this approach could be implemented, there need to be guidelines on the minimum gain in life-expectancy needed to refer a person for lung cancer screening. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The life-gained approach could be considered for any type of screening.  A key advantage of life-gained versus risk is that the life-gained approach naturally obviates the need to define an upper age to curtail cancer screening. As long as the patient stands to gain sufficient life-years from screening, s/he could continue to get screened.

Citation:

Life-Gained–Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening

Li C. Cheung, PhD; Christine D. Berg, MD; Philip E. Castle, PhD; Hormuzd A. Katki, PhD *; Anil K. Chaturvedi, PhD
Published: Ann Intern Med. 2019.
DOI: 10.7326/M19-1263

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Oct 23, 2019 @ 8:25 pm 

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