Benchmarking lung cancer mortality rates in current and former smokers.
OBJECTIVE
To develop and validate a model for estimating the risk of lung cancer death in current and former smokers. The model is intended for use in analyzing a population of subjects who are undergoing lung cancer screening or receiving lung cancer chemoprevention, to determine whether the intervention has altered lung cancer mortality.


METHODS
Model derivation was based on analyses of the placebo arm of the Carotene and Retinol Efficacy Trial. Model validation was based on analyses of three other longitudinal cohorts.


METHODS
Observed and predicted number of deaths due to lung cancer.


RESULTS
In internal validation, the model was highly concordant and well calibrated. In external validation, the model predictions were similar to what was observed in all of the validation analyses. The predicted and observed deaths within 6 years were very similar when assessed in the Johns Hopkins Hospital trial of chest radiography and sputum cytology screening (176 predicted, 184 observed, p = 0.53), the Memorial Sloan-Kettering Cancer Center trial of chest radiography and sputum cytology screening (108 predicted, 114 observed, p = 0.57), and the National Health and Nutrition Evaluation Survey part I (24 predicted, 21 observed, p = 0.52).


CONCLUSIONS
The number of lung cancer deaths in a population of current or former smokers can be accurately predicted, making model-based evaluations of prevention and early detection interventions a useful adjunct to definitive randomized trials. We illustrate this potential use with a small example.
Bach
Peter B
PB
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 221, New York, NY 10021, USA. bachp@mskcc.org
Elkin
Elena B
EB
Pastorino
Ugo
U
Kattan
Michael W
MW
Mushlin
Alvin I
AI
Begg
Colin B
CB
Parkin
D Maxwell
DM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate