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Aggarwal R, Lam AC, Huang J, Hueniken K, Nguyen D, Khan K, Shaikh T, Shepherd FA, Tsao MS, Xu W, Kavanagh J, Liu G. Stratification and management of patients ineligible for lung cancer screening. Respir Med 2021; 188:106610. [PMID: 34592536 DOI: 10.1016/j.rmed.2021.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/26/2021] [Accepted: 09/05/2021] [Indexed: 11/16/2022]
Abstract
This study identifies participants ineligible for lung cancer screening with the greatest likelihood of future eligibility. Lung cancer risk in participants enrolled in longitudinal lung screening was assessed using the Prostate, Lung, Colorectal and Ovarian lung cancer risk calculator (PLCOm2012) at two timepoints: baseline (T1) and follow-up (T2). Separate analyses were performed on four PLCOm2012 eligibility thresholds (3.25%, 2.00%, 1.50%, and 1.00%); only participants with a T1 risk less than the threshold were included in that analysis. Cox-models identified T1 risk factors associated with screen-eligibility at T2. Three models, applying differing assumptions of participant behavior, predicted future eligibility and were benchmarked against the observed cohort. Nine hundred and fifty-six participants had a T1 risk <3.25%; at 2.00% n= 755; at 1.50% n= 652; at 1.00% n= 484. Lung cancer risk increased over time in most screen-ineligible participants. However, risk increased much faster in participants who became screen-eligible at T2 compared to those who remained screen-ineligible (median per-year increase of 0.35% versus 0.02%, when using a 3.25% threshold). Participants smoking for >30 years, current smokers, less educated participants, and those with chronic obstructive pulmonary disease (COPD) at T1 were significantly more likely to become screen-eligible. New diagnoses of COPD and/or non-lung cancers between T1 and T2 precipitated eligibility in a subset of participants. The prediction model that assumed health behaviors observed at T1 continued to T2 reasonably predicted changes in lung cancer risk. This prediction model and the identified baseline risk factors can identify screen-ineligible participants who should be closely followed for future eligibility.
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Affiliation(s)
- Reenika Aggarwal
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Andrew Cl Lam
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Jingyue Huang
- Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Katrina Hueniken
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Daniel Nguyen
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Khaleeq Khan
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Taariq Shaikh
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - Frances A Shepherd
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
| | - Ming-Sound Tsao
- Department of Pathology, Laboratory Medicine, University Health Network, 585 University Ave, Toronto, M5B 2N2, Canada; Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, M5G 1L7, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Department of Biostatistics, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada
| | - John Kavanagh
- Joint Department of Medical Imaging, University Health Network, 263 McCaul St, Toronto, M5T 1W7, Canada.
| | - Geoffrey Liu
- Division of Medical Oncology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, M5G 2C1, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, M5T 3M7, Canada; Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada; Department of Medical Biophysics, University of Toronto, 101 College St, Toronto, M5G 1L7, Canada; Institute of Medical Science, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada; Pharmacology and Toxicology, University of Toronto, 1 King's College Cir, Toronto, M5S 1A8, Canada
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