Monday, February 25, 2013

Research Highlights: New Model for Lung Cancer Screening More Effective, Study Shows

New Model for Lung Cancer Screening Selection Criteria Shown to Be More Effective

by: Joseph St. Pierre

Recommending lung cancer screening on patients deemed to be high-risk according to the current model developed by National Lung Cancer Trial (NLCT) has been shown to lower the overall mortality rate of the disease by 20%.The applied criteria include being between 55 and 74 years of age, having a history of smoking of at least 30 pack-years, a period of less than 15 years since cessation of smoking, or a modified set of requirements based on the former criteria. However, according to an article published by the New England Journal of Medecine, researchers have developed a modified model based off of risk factors used in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. The new model, which analyzes additional risk-based factors like BMI, family history, and smoking status, has be shown to be significantly more efficient at marking patients as high-risk and increasing diagnosis yield.

The study was performed by analyzing the intervention and control group data of the two aforementioned studies, NLCT and PLCO, which encompassed 53,202 and 80,375 smokers, respectively. An additional group composed of 15,099 PLCO intervention group members who met the NLST criteria was also included. Statistical analysis compared the effectiveness of the new, modified PLCO risk-based model, named PLCOM2012 , with the unmodified NLCT criteria. Compared to NLCT criteria, PLCOM2012 had significantly increased sensitivity and positive predictive value, allowing it to miss 41.3% less lung cancer diagnoses.

While this data may imply that PLCOM2012  is an obvious improvement over current lung cancer screening methods, it should be noted that PLCOM2012 is far more difficult to apply than its predecessor, as it hinges on complex modeling and the use of multivariate statistics. Furthermore, PLCOM2012 occasionally uses parameters, such as follow-up time, that differ from its older counterpart, rendering certain comparisons inaccurate. However, in dealing with an affliction whose early detection is key to successful treatment, such findings and research are, at the very least, yet another step towards more a more efficient means of recognizing at-risk individuals.

NEJM. 2013. 368:728-736

Joseph St. Pierre is the 2012-2013 Tuftscope Research Highlights Editor

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