title: Personalizing annual lung cancer screening for patients with chronic obstructive pulmonary disease: A decision analysis.
abstract: BACKGROUND
  Lung cancer screening with annual chest computed tomography (CT) is recommended for current and former smokers with a ≥30-pack-year smoking history. Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of developing lung cancer and may benefit from screening at lower pack-year thresholds.
  
  
  METHODS
  We used a previously validated simulation model to compare the health benefits of lung cancer screening in current and former smokers ages 55-80 with ≥30 pack-years with hypothetical programs using lower pack-year thresholds for individuals with COPD (≥20, ≥10, and ≥1 pack-years). Calibration targets for COPD prevalence and associated lung cancer risk were derived using the Framingham Offspring Study limited data set. We performed sensitivity analyses to evaluate the stability of results across different rates of adherence to screening, increased competing mortality risk from COPD, and increased surgical ineligibility in individuals with COPD. The primary outcome was projected life expectancy.
  
  
  RESULTS
  Programs using lower pack-year thresholds for individuals with COPD yielded the highest life expectancy gains for a given number of screens. Highest life expectancy was achieved when lowering the pack-year threshold to ≥1 pack-year for individuals with COPD, which dominated all other screening strategies. These results were stable across different adherence rates to screening and increases in competing mortality risk for COPD and surgical ineligibility.
  
  
  CONCLUSIONS
  Current and former smokers with COPD may disproportionately benefit from lung cancer screening. A lower pack-year threshold for screening eligibility may benefit this high-risk patient population.
authors: Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital, Institute for Technology Assessment, Boston, Massachusetts.
authors: Kathryn P
authors: KP
authors: Lowry
authors: G Scott
authors: GS
authors: Gazelle
authors: Michael E
authors: ME
authors: Gilmore
authors: Colden
authors: C
authors: Johanson
authors: Vidit
authors: V
authors: Munshi
authors: Sung Eun
authors: SE
authors: Choi
authors: Angela C
authors: AC
authors: Tramontano
authors: Chung Yin
authors: CY
authors: Kong
authors: Pamela M
authors: PM
authors: McMahon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003198:Computer Simulation / Q000706:statistics & numerical data*; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods / Q000592:standards / Q000639:trends; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards / Q000639:trends; D008875:Middle Aged; D057285:Precision Medicine / Q000379:methods / Q000592:standards / Q000639:trends; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D012123:Pulmonary Ventilation; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology
keywords: cancer screening; chronic obstructive pulmonary disease; decision analysis; lung neoplasms
references: Ann Intern Med. 2008 Apr 1;148(7):535-43
references: 18316746
references: Eur Respir J. 2007 Aug;30(2):232-9
references: 17666557
references: Biometrics. 1994 Mar;50(1):270-8
references: 8086610
references: N Engl J Med. 2013 Feb 21;368(8):728-36
references: 23425165
references: Ann Intern Med. 2014 Mar 4;160(5):311-20
references: 24379002
references: PLoS One. 2011 Feb 03;6(2):e16476
references: 21304900
references: Ann Intern Med. 2012 Jan 3;156(1 Pt 1):68-9; author reply 69
references: 22213504
references: Nat Rev Cancer. 2013 Apr;13(4):233-45
references: 23467302
references: Am J Respir Crit Care Med. 2008 Oct 1;178(7):738-44
references: 18565949
references: Eur Respir J. 2009 Aug;34(2):380-6
references: 19196816
references: PLoS One. 2009 Oct 08;4(10):e7380
references: 19812684
references: N Engl J Med. 2011 Aug 4;365(5):395-409
references: 21714641
references: Int J Chron Obstruct Pulmon Dis. 2009;4:137-48
references: 19436692
references: Cancer. 2008 Dec 15;113(12):3440-9
references: 18988293
references: Ann Intern Med. 2014 Mar 4;160(5):330-8
references: 24378917
references: J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8
references: 22710039
references: Eur Respir J. 2010 Jan;35(1):146-51
references: 19679603
references: Arch Intern Med. 2000 Jun 12;160(11):1683-9
references: 10847262
references: Prev Med. 1975 Dec;4(4):518-25
references: 1208363
references: Am J Respir Crit Care Med. 1998 May;157(5 Pt 1):1445-51
references: 9603122
references: Respir Med. 2013 May;107(5):702-7
references: 23465176
references: J Thorac Oncol. 2011 Nov;6(11):1841-8
references: 21892105
references: Thorax. 2004 Aug;59(8):679-81
references: 15282388
references: Thorax. 2007 Jan;62(1):51-6
references: 16928722
references: Ann Intern Med. 2012 Aug 21;157(4):242-50
references: 22910935
references: Eur Respir J. 2005 Nov;26(5):948-68
references: 16264058
references: Respir Med. 2014 May;108(5):815
references: 24594144
references: Radiology. 2011 Jan;258(1):243-53
references: 21045183
references: Thorax. 2005 Jul;60(7):570-5
references: 15994265
references: Respir Med. 2014 May;108(5):813-4
references: 24679440
references: Arch Intern Med. 2003 Jun 23;163(12):1475-80
references: 12824098
references: Value Health. 2009 Jun;12(4):521-9
references: 19900254
references: Chest. 2005 Oct;128(4):1895-7
references: 16236829
references: Eur Respir J. 2012 Oct;40(4):1063-4
references: 23024333
references: Radiology. 2008 Jul;248(1):278-87
references: 18458247
references: J Natl Compr Canc Netw. 2012 Feb;10(2):240-65
references: 22308518
references: Ann Intern Med. 1986 Oct;105(4):503-7
references: 3752756
references: Cancer. 2014 Jun 1;120(11):1713-24
references: 24577803