title: Improving selection criteria for lung cancer screening. The potential role of emphysema.
abstract: BACKGROUND
  Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ≥30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity.
  
  
  OBJECTIVE
  To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion.
  
  
  METHODS
  Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema.
  
  
  RESULTS
  Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%.
  
  
  CONCLUSIONS
  LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.
authors: 1 Pulmonary Department and.
authors: Pablo
authors: P
authors: Sanchez-Salcedo
authors: David O
authors: DO
authors: Wilson
authors: Juan P
authors: JP
authors: de-Torres
authors: Joel L
authors: JL
authors: Weissfeld
authors: Juan
authors: J
authors: Berto
authors: Arantzazu
authors: A
authors: Campo
authors: Ana B
authors: AB
authors: Alcaide
authors: Jesús
authors: J
authors: Pueyo
authors: Gorka
authors: G
authors: Bastarrika
authors: Luis M
authors: LM
authors: Seijo
authors: Maria J
authors: MJ
authors: Pajares
authors: Ruben
authors: R
authors: Pio
authors: Luis M
authors: LM
authors: Montuenga
authors: Javier J
authors: JJ
authors: Zulueta
mesh_terms: D000368:Aged; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D018579:Patient Selection; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: National Lung Screening Trial; emphysema; low-dose computed tomography; lung cancer screening