• Lauren E Kearney, Patrick Belancourt, Hormuzd A Katki, Nichole T Tanner, Renda Soylemez Wiener, Hilary A Robbins, Rebecca Landy, and Tanner J Caverly.
• Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, and The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts (L.E.K.).
• Ann. Intern. Med. 2024 Sep 1; 177 (9): 122212321222-1232.

BackgroundThe recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.ObjectiveTo determine whether alternative criteria can identify these high-benefit people.DesignModel-based projections.SettingUnited States.ParticipantsPeople from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.MeasurementsLife-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. "High-benefit" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.ResultsThe final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; P < 0.001) and specificity (86% vs. 84%; P < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [P < 0.001]; Hispanic: 95% vs. 73% [P = 0.086]; Asian: 94% vs. 68% [P = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities.LimitationThe results were based on model projections.ConclusionThese results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups.Primary Funding SourceU.S. Department of Veterans Affairs Lung Precision Oncology Program.

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