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Life-Gained Approach to Lung Cancer Screening May Increase Life Expectancy

, by DCEG Staff

Physician reviews a CT scan of the lungs.

Life-gained approach to lung cancer screening resulted in the greatest increase in life expectancy compared to risk-based strategies and current guidelines, according to findings published in Annals of Internal Medicine on October 22, 2019.

Li C. Cheung, Ph.D., staff scientist in the Biostatistics Branch, and colleagues, developed and validated a new model to estimate an individual’s years of life gained from low-dose computed tomography (CT) screening for lung cancer. They found that both risk-based and life-gained-based strategies may prevent more lung cancer deaths and result in greater gains to life expectancy, compared to current US Preventive Services Task Force (USPSTF) guidelines. Life-gained-based selection resulted in the greatest gains in life-expectancy, while risk-based selection prevented more lung cancer deaths.

Currently, the USPSTF recommends screening for smokers aged 55 to 80 who currently smoke or have quit within the past 15 years and have a 30 pack-year history of cigarette smoking. Many studies have shown that risk-based screening could prevent substantially more lung cancer deaths than current USPSTF guidelines. However, risk-based screening would provide a modest increase in life expectancy compared to current guidelines and would recommend screening more older smokers with other medical conditions for whom the harms of screening may outweigh the benefits.

The life-gained approach could be considered for any type of screening. Using the individualized life-years gained from screening strategy is an attractive alternative to individualized risk because it also accounts for a patient’s life-expectancy, and thus their overall health, improving the benefit vs harms trade-offs of those referred to screening. In principle, a key advantage of the life-gained approach is it naturally obviates the need to define ages to start or stop screening. Instead, a patient can start and continue screening, as long as the patient stands to gain sufficient life-years from screening.


Cheung, LC et al. Life-gained–based versus risk-based selection of smokers for lung cancer screeningAnnals of Internal Medicine, October 22, 2019. DOI: 10.7326/M19-1263 [Epub before print]

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