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Longer Intervals Between Lung Cancer Screens Could Reduce False-Positives for Low-Risk Patients

, by DCEG Staff

A personalized approach for choosing how long to wait between lung cancer screenings could improve efficiency and reduce harms such as false-positives, according to a study published in the Journal of the National Cancer Institute on 12 April 2019.

The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 55 to 80 who have a 30-pack-year smoking history and currently smoke, or have quit within the past 15 years. Within the group of eligible participants, some are at much higher risk than others, based on age, more pack-years smoked, or less quit-time. As a result, the frequency of screening can result in excess harm for eligible individuals at the lower end of the risk spectrum.

In a new study, investigators at the National Cancer Institute and the International Agency for Research on Cancer analyzed over 23,000 participants from the National Lung Screening Trial (NLST) who had negative LDCT screening results. They developed a model to predict an individual’s risk of being diagnosed with lung cancer at the next annual screen based on their age, detailed smoking history and other health factors, and information from their recent negative LDCT scan such as the presence of emphysema.

Applying this model to NLST data, the authors studied the potential effects of lengthening the screening interval beyond one year for those with a negative screen result and the lowest future risk. They found that this could substantially reduce the harms from screening such as false-positives, radiation exposure, and cost, while delaying diagnosis for a relatively small number of cancers.

More research is needed to test the new model in modern screening programs and to determine whether an individualized approach to lung cancer screening intervals will be acceptable to patients.

Reference:

Robbins HA, Berg CD, Cheung LC, Chaturvedi AK, KatkiHA. Identification of candidates for longer lung cancer screening intervals following a negative low-dose computed tomography result. J National Cancer Inst. April 12, 2019. DOI: 10.1093/jnci/djz041 [Epub ahead of print]

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