PMID- 25460915
OWN - NLM
STAT- MEDLINE
DCOM- 20150901
LR  - 20220409
IS  - 1549-1676 (Electronic)
IS  - 1549-1277 (Print)
IS  - 1549-1277 (Linking)
VI  - 11
IP  - 12
DP  - 2014 Dec
TI  - Evaluation of the lung cancer risks at which to screen ever- and never-smokers: 
      screening rules applied to the PLCO and NLST cohorts.
PG  - e1001764
LID - 10.1371/journal.pmed.1001764 [doi]
LID - e1001764
AB  - BACKGROUND: Lung cancer risks at which individuals should be screened with 
      computed tomography (CT) for lung cancer are undecided. This study's objectives 
      are to identify a risk threshold for selecting individuals for screening, to 
      compare its efficiency with the U.S. Preventive Services Task Force (USPSTF) 
      criteria for identifying screenees, and to determine whether never-smokers should 
      be screened. Lung cancer risks are compared between smokers aged 55-64 and >/= 
      65-80 y. METHODS AND FINDINGS: Applying the PLCO(m2012) model, a model based on 
      6-y lung cancer incidence, we identified the risk threshold above which National 
      Lung Screening Trial (NLST, n = 53,452) CT arm lung cancer mortality rates were 
      consistently lower than rates in the chest X-ray (CXR) arm. We evaluated the 
      USPSTF and PLCO(m2012) risk criteria in intervention arm (CXR) smokers (n = 
      37,327) of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial 
      (PLCO). The numbers of smokers selected for screening, and the sensitivities, 
      specificities, and positive predictive values (PPVs) for identifying lung cancers 
      were assessed. A modified model (PLCOall2014) evaluated risks in never-smokers. 
      At PLCO(m2012) risk >/= 0.0151, the 65th percentile of risk, the NLST CT arm 
      mortality rates are consistently below the CXR arm's rates. The number needed to 
      screen to prevent one lung cancer death in the 65th to 100th percentile risk 
      group is 255 (95% CI 143 to 1,184), and in the 30th to <65th percentile risk 
      group is 963 (95% CI 291 to -754); the number needed to screen could not be 
      estimated in the <30th percentile risk group because of absence of lung cancer 
      deaths. When applied to PLCO intervention arm smokers, compared to the USPSTF 
      criteria, the PLCO(m2012) risk >/= 0.0151 threshold selected 8.8% fewer individuals 
      for screening (p<0.001) but identified 12.4% more lung cancers (sensitivity 80.1% 
      [95% CI 76.8%-83.0%] versus 71.2% [95% CI 67.6%-74.6%], p<0.001), had fewer 
      false-positives (specificity 66.2% [95% CI 65.7%-66.7%] versus 62.7% [95% CI 
      62.2%-63.1%], p<0.001), and had higher PPV (4.2% [95% CI 3.9%-4.6%] versus 3.4% 
      [95% CI 3.1%-3.7%], p<0.001). In total, 26% of individuals selected for screening 
      based on USPSTF criteria had risks below the threshold PLCO(m2012) risk >/= 0.0151. 
      Of PLCO former smokers with quit time >15 y, 8.5% had PLCO(m2012) risk >/= 0.0151. 
      None of 65,711 PLCO never-smokers had PLCO(m2012) risk >/= 0.0151. Risks and lung 
      cancers were significantly greater in PLCO smokers aged >/= 65-80 y than in those 
      aged 55-64 y. This study omitted cost-effectiveness analysis. CONCLUSIONS: The 
      USPSTF criteria for CT screening include some low-risk individuals and exclude 
      some high-risk individuals. Use of the PLCO(m2012) risk >/= 0.0151 criterion can 
      improve screening efficiency. Currently, never-smokers should not be screened. 
      Smokers aged >/= 65-80 y are a high-risk group who may benefit from screening. 
      Please see later in the article for the Editors' Summary.
FAU - Tammemagi, Martin C
AU  - Tammemagi MC
AD  - Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
FAU - Church, Timothy R
AU  - Church TR
AD  - School of Public Health, University of Minnesota, Minneapolis, Minnesota, United 
      States of America.
FAU - Hocking, William G
AU  - Hocking WG
AD  - Marshfield Clinic, Marshfield, Wisconsin, United States of America.
FAU - Silvestri, Gerard A
AU  - Silvestri GA
AD  - Pulmonary and Critical Care Medicine, Medical University of South Carolina, 
      Charleston, South Carolina, United States of America.
FAU - Kvale, Paul A
AU  - Kvale PA
AD  - Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, 
      Michigan, United States of America.
FAU - Riley, Thomas L
AU  - Riley TL
AD  - Information Management Systems, Rockville, Maryland, United States of America.
FAU - Commins, John
AU  - Commins J
AD  - Information Management Systems, Rockville, Maryland, United States of America.
FAU - Berg, Christine D
AU  - Berg CD
AD  - Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins 
      Medicine, Baltimore, Maryland, United States of America.
LA  - eng
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20141202
PL  - United States
TA  - PLoS Med
JT  - PLoS medicine
JID - 101231360
SB  - IM
EIN - PLoS Med. 2015 Jan;12(1):e1001787. PMID: 25629614
MH  - Aged
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Humans
MH  - Lung Neoplasms/*diagnosis
MH  - Male
MH  - Mass Screening/*statistics & numerical data
MH  - Middle Aged
MH  - Risk Assessment
MH  - Smoking/*adverse effects
PMC - PMC4251899
COIS- CB is a consultant for Medial Cancer Screening, Ltd., a diagnostic algorithm 
      start-up company based in Tel Aviv working on improved methods of early detection 
      of cancer using pre-existing information in the medical record.
EDAT- 2014/12/03 06:00
MHDA- 2015/09/02 06:00
PMCR- 2014/12/02
CRDT- 2014/12/03 06:00
PHST- 2014/04/01 00:00 [received]
PHST- 2014/10/21 00:00 [accepted]
PHST- 2014/12/03 06:00 [entrez]
PHST- 2014/12/03 06:00 [pubmed]
PHST- 2015/09/02 06:00 [medline]
PHST- 2014/12/02 00:00 [pmc-release]
AID - PMEDICINE-D-14-01117 [pii]
AID - 10.1371/journal.pmed.1001764 [doi]
PST - epublish
SO  - PLoS Med. 2014 Dec 2;11(12):e1001764. doi: 10.1371/journal.pmed.1001764. 
      eCollection 2014 Dec.