Lung cancer is a serious problem, and early detection through screening is crucial in saving lives. However, the traditional method of selecting smokers for screening, which is based on high risk, prioritize older smokers with shorter life expectancies and more health problems. A new study published in the Annals of Internal Medicine has explored a new approach to selecting smokers for screening that is based on life expectancy instead of just risk.
The LYFS-CT study analysed the health records of over 130,000 smokers in the US from 1997 to 2015. This represented about 60 million smokers in the country. The goal of the study was to compare a new way of selecting smokers for lung cancer screening, called the life-gained-based selection strategy, to the traditional risk-based selection method.
The results showed that the life-gained-based strategy, which would select 8.3 million smokers, would increase the total life expectancy of those who undergo CT screening by 26,000 years (633,400 vs. 607,800 years) . However, it would prevent fewer lung cancer deaths (52,600 compared to 55,000) compared to the traditional method. The smokers selected by the life-gained-based strategy were younger, with an average age of 59, compared to those selected by the risk-based strategy who had an average age of 75. Additionally, the smokers selected by the life-gained-based strategy had fewer health problems, with an average of 0.75 health issues, compared to those selected by the risk-based strategy who had an average of 3.7 health issues.
The LYFS-CT study highlights the importance of considering both life expectancy and overall health outcomes when selecting smokers for lung cancer screening. The life-gained-based selection strategy maximizes the benefits of screening by including ever-smokers who have both high lung cancer risk and long life expectancy. This new approach could potentially save lives and improve health outcomes for those selected for screening.
In conclusion, the LYFS-CT study provides evidence that a life-gained-based selection strategy for lung cancer screening could be a game-changer in improving health outcomes and saving lives. The proposed framework has the potential to unify metrics for cancer screening across various stakeholders and could form the basis for determining screening thresholds. A shift to life-gained-based selection could have broad implications for precision cancer screening and address key issues facing population-wide cancer screening.
Other problems of the lung cancer screening criteria
Using Risk Models to Make Lung Cancer Screening Decisions: Evidence-Based and Getting Better Tanner J. Caverly and Rafael Meza. Ann Intern Med. 2019 Nov 5;171(9):623-632. doi: 10.7326/M19-1263.