Background Lung cancer screening is effective for people at higher risk of the disease, but there is no international consensus on eligibility criteria. Some programmes use risk factors; others use multivariable risk scores, which might target an older, more comorbid population and thus limit life years gained. In this study, we compare frailty, comorbidities and overall survival between different eligible populations.
Methods Participants aged 55–74 years undergoing lung cancer risk assessment in the Yorkshire Lung Screening Trial were analysed, comparing those who met the US Preventive Services Task Force 2021 lung cancer screening criteria (USPSTF2021) criteria against established risk-based criteria currently used in screening protocols (Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial risk model (PLCOm2012) ≥1.51%, used internationally, and the Liverpool Lung Project risk model (version 2) (LLPv2) ≥2.5%, used in the UK), examining the number of individuals with frailty and comorbidities selected by each approach. In addition, risk score thresholds were set to select equivalent numbers of people screened compared with USPSTF2021. Data recorded in primary care prior to randomisation were retrospectively extracted to allow calculation of the electronic Frailty Index (eFI) and an overall comorbidity count. Frailty, comorbidity counts and 3-year overall survival were compared between these various populations.
Results Of 11 994 individuals aged 55–74 undergoing risk assessment, 3502 were eligible by USPSTF2021, 3139 by PLCOm2012 ≥1.51% and 3957 by LLPv2 ≥2.5%. The proportion of individuals with moderate/severe frailty was lower for the USPSTF2021 population (10.6%) compared with PLCOm2012 ≥1.51% (13.1%, adjusted p=0.0777) and LLPv2 ≥2.5% (13.4%, adjusted p=0.0272). The USPSTF2021 identified significantly fewer individuals with multiple comorbidities (30.8%) than the PLCOm2012 (36.1%, adjusted p=0.0033) and the LLPv2 (37.3%, adjusted p=0.0001).
When compared in equivalent populations, both PLCOm2012 with a threshold of 1.32%, and LLPv2 with a threshold of 2.92%, had a higher proportion of people both with moderate/severe frailty (12.6%, adjusted p=0.221 and 14.0%, adjusted p=0.0067 respectively) and multiple comorbidities (35.1%, adjusted p=0.0211 and 38.5%, adjusted p<0.0001 respectively) than USPSTF2021.
There were no apparent differences in 3-year overall survival between the eligible populations overlapping 95% CIs across risk groups.
Conclusion These data suggest that currently used risk models identify populations with a small increase in moderate/severe frailty and multimorbidity compared to the USPSTF2021 criteria, but there is no evidence to suggest that this results in differences in 3-year overall survival.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)