Objective:

To evaluate the effectiveness of risk-based lung cancer screening strategies compared to current USPSTF eligibility criteria.

Approach:

• Study Design: A large cohort study assessing 16 lung cancer risk prediction models among over 641,000 US adults aged 50 to 80 with a smoking history.
• Population: Participants included diverse racial and ethnic groups: Asian, Hispanic, non-Hispanic Black, and non-Hispanic White individuals.
• Performance Evaluation: Comparison of risk-model thresholds to USPSTF criteria to assess screening efficiency and racial/ethnic disparities.

Key Findings:

• Existing prediction models significantly underestimated lung cancer risk in non-Hispanic Black participants.
• Lower discrimination was observed in Asian participants compared to all other groups.
• Risk-based strategies improved average screening efficiency and reduced differences across racial and ethnic groups compared to USPSTF criteria.
• Some models did not improve estimated screening efficiency among non-Hispanic Black participants compared to USPSTF criteria.
• No single strategy optimized all performance measures equally well.

Interpretation:

Risk-based strategies were superior to USPSTF criteria in optimizing efficiency and minimizing variation across racial and ethnic groups.

Limitations:

• Underrepresentation of racial and ethnic minority groups, particularly Asian and Hispanic participants.
• Inability to evaluate model performance among Native Hawaiian or other Pacific Islander and American Indian or Alaska Native participants due to small sample sizes.

Conclusion:

While risk-based approaches enhance screening efficiency, disparities in performance across racial and ethnic groups persist.

Sources:

• Annals of Internal Medicine