title: Identifying high risk individuals for targeted lung cancer screening: Independent validation of the PLCOm2012risk prediction tool.
abstract: Lung cancer screening with computerised tomography holds promise, but optimising the balance of benefits and harms via selection of a high risk population is critical. PLCOm2012is a logistic regression model based on U.S. data, incorporating sociodemographic and health factors, which predicts 6-year lung cancer risk among ever-smokers, and thus may better predict those who might benefit from screening than criteria based solely on age and smoking history. We aimed to validate the performance of PLCOm2012in predicting lung cancer outcomes in a cohort of Australian smokers. Predicted risk of lung cancer was calculated using PLCOm2012applied to baseline data from 95,882 ever-smokers aged ≥45 years in the 45 and Up Study (2006-2009). Predictions were compared to lung cancer outcomes captured to June 2014 via linkage to population-wide health databases; a total of 1,035 subsequent lung cancer diagnoses were identified. PLCOm2012had good discrimination (area under the receiver-operating-characteristic-curve; AUC 0.80, 95%CI 0.78-0.81) and excellent calibration (mean and 90th percentiles of absolute risk difference between observed and predicted outcomes: 0.006 and 0.016, respectively). Sensitivity (69.4%, 95%CI, 65.6-73.0%) of the PLCOm2012criteria in the 55-74 year age group for predicting lung cancers was greater than that using criteria based on ≥30 pack-years smoking and ≤15 years quit (57.3%, 53.3-61.3%; p < 0.0001), but specificity was lower (72.0%, 71.7-72.4% versus 75.2%, 74.8-75.6%, respectively; p < 0.0001). Targeting high risk people for lung cancer screening using PLCOm2012might improve the balance of benefits versus harms, and cost-effectiveness of lung cancer screening.
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.|School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia.
authors.forename: Marianne
authors.identifier: 0000-0001-5731-9651
authors.initials: M
authors.lastname: Weber
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.
authors.forename: Sarsha
authors.initials: S
authors.lastname: Yap
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Goldsbury
authors.affiliation: Midland Physician Service, St John of God Public and Private Hospitals Midland, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Manners
authors.affiliation: Department Health Sciences, Brock University, Ontario, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Tammemagi
authors.affiliation: Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Marshall
authors.affiliation: Curtin Medical School, Faculty of Health Sciences, Curtin University, Western Australia, Australia.
authors.forename: Fraser
authors.initials: F
authors.lastname: Brims
authors.affiliation: Fiona Stanley Hospital, Respiratory Medicine Department, University of Western Australia, Western Australia, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: McWilliams
authors.affiliation: Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.
authors.forename: Kwun
authors.initials: K
authors.lastname: Fong
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Kang
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Caruana
authors.affiliation: National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Australian Capital Territory, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Banks
authors.affiliation: Cancer Research Division, Cancer Council NSW, New South Wales, Australia.|School of Public Health, Sydney Medical School, University of Sydney, New South Wales, Australia.|Prince of Wales Clinical School, UNSW, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Canfell
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*
keywords: low dose computed tomography; lung cancer; mass screening; risk prediction model