Lung cancer screenings were in the news in January when twin studies in Annals of Internal Medicine showed that using them based on individual risk could potentially save more lives than current recommendations but could be pricey, and not offer substantial gains in life-years saved or quality-adjusted-life-years (QALYs).

The first, from researchers at the National Cancer Institute (NCI), compared the eligibility criteria of the U.S. Preventive Services Task Force (USPSTF).


“There is growing consensus in the field that the current USPSTF guidelines may exclude some smokers at high risk of lung cancer who could also benefit from lung cancer screening,” Li C. Cheung, an NCI statistician and one of the coauthors of the first study, told HCB News. “The use of individualized risk calculators and individualized risk-based screening could guard against such exclusion of high-risk smokers from screening. Future screening guidelines may well incorporate individualized risk-based screening thresholds for the selection of smokers.”

Researchers at Tufts Medical Center conducted the second study, which looked at the cost-effectiveness of a risk-targeted screening strategy against criteria of the National Lung Screening Trial by estimating the QALYs gained, relative to the cost of screening.

Though targeting low-dose CT (LDCT) was found to more likely detect cancer in high-risk patients and avert death over all seven years of the trial, such patients were found to be older, with greater smoking exposure, and more likely to have a preexisting diagnosis of chronic obstructive pulmonary disease, giving them a shorter life expectancy and lower quality of life, according to the researchers.

Researchers concluded that preventing death in such patients produced fewer QALYs than in those with lower risk.

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