title: Selection criteria for lung-cancer screening.
abstract: BACKGROUND
  The National Lung Screening Trial (NLST) used risk factors for lung cancer (e.g., ≥30 pack-years of smoking and <15 years since quitting) as selection criteria for lung-cancer screening. Use of an accurate model that incorporates additional risk factors to select persons for screening may identify more persons who have lung cancer or in whom lung cancer will develop.
  
  
  METHODS
  We modified the 2011 lung-cancer risk-prediction model from our Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial to ensure applicability to NLST data; risk was the probability of a diagnosis of lung cancer during the 6-year study period. We developed and validated the model (PLCO(M2012)) with data from the 80,375 persons in the PLCO control and intervention groups who had ever smoked. Discrimination (area under the receiver-operating-characteristic curve [AUC]) and calibration were assessed. In the validation data set, 14,144 of 37,332 persons (37.9%) met NLST criteria. For comparison, 14,144 highest-risk persons were considered positive (eligible for screening) according to PLCO(M2012) criteria. We compared the accuracy of PLCO(M2012) criteria with NLST criteria to detect lung cancer. Cox models were used to evaluate whether the reduction in mortality among 53,202 persons undergoing low-dose computed tomographic screening in the NLST differed according to risk.
  
  
  RESULTS
  The AUC was 0.803 in the development data set and 0.797 in the validation data set. As compared with NLST criteria, PLCO(M2012) criteria had improved sensitivity (83.0% vs. 71.1%, P<0.001) and positive predictive value (4.0% vs. 3.4%, P=0.01), without loss of specificity (62.9% and. 62.7%, respectively; P=0.54); 41.3% fewer lung cancers were missed. The NLST screening effect did not vary according to PLCO(M2012) risk (P=0.61 for interaction).
  
  
  CONCLUSIONS
  The use of the PLCO(M2012) model was more sensitive than the NLST criteria for lung-cancer detection.
authors: Department of Community Health Sciences, Brock University, St. Catharines, ON, Canada. martin.tammemagi@brocku.ca
authors: Martin C
authors: MC
authors: Tammemägi
authors: Hormuzd A
authors: HA
authors: Katki
authors: William G
authors: WG
authors: Hocking
authors: Timothy R
authors: TR
authors: Church
authors: Neil
authors: N
authors: Caporaso
authors: Paul A
authors: PA
authors: Kvale
authors: Anil K
authors: AK
authors: Chaturvedi
authors: Gerard A
authors: GA
authors: Silvestri
authors: Tom L
authors: TL
authors: Riley
authors: John
authors: J
authors: Commins
authors: Christine D
authors: CD
authors: Berg
mesh_terms: D019540:Area Under Curve; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008403:Mass Screening; D018579:Patient Selection; D013902:Radiography, Thoracic; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012907:Smoking; D014057:Tomography, X-Ray Computed