European journal of epidemiology
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As randomized trials in the USA and Europe have convincingly demonstrated efficacy of lung cancer screening by computed tomography (CT), European countries are discussing the introduction of screening programs. To maintain acceptable cost-benefit and clinical benefit-to-harm ratios, screening should be offered to individuals at sufficiently elevated risk of having lung cancer. Using federal-wide survey and lung cancer incidence data (2008-2013), we examined the performance of four well-established risk models from the USA (PLCOM2012, LCRAT, Bach) and the UK (LLP2008) in the German population, comparing with standard eligibility criteria based on age limits, minimal pack years of smoking (or combination of total duration with average intensity) and maximum years since smoking cessation. ⋯ Compared to eligibility criteria (e.g. USPSTF), risk models elected individuals in higher age groups, including ex-smokers with longer average quitting times. Further studies should address how in Germany these shifts may affect expected benefits of CT screening in terms of life-years gained versus the potential harm of age-specific increasing risk of over-diagnosis.