Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom.

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ICR Authors

Schoemaker, Minouk

Authors

Robbins, HA
Alcala, K
Swerdlow, AJ
Schoemaker, MJ
Wareham, N
Travis, RC
Crosbie, PAJ
Callister, M
Baldwin, DR
Landy, R
Johansson, M

Document Type

Journal Article

Date

2021-06-08

Date Accepted

2021-01-13

Abstract

BACKGROUND: The National Health Service England (NHS) classifies individuals as eligible for lung cancer screening using two risk prediction models, PLCOm2012 and Liverpool Lung Project-v2 (LLPv2). However, no study has compared the performance of lung cancer risk models in the UK. METHODS: We analysed current and former smokers aged 40-80 years in the UK Biobank (N = 217,199), EPIC-UK (N = 30,813), and Generations Study (N = 25,777). We quantified model calibration (ratio of expected to observed cases, E/O) and discrimination (AUC). RESULTS: Risk discrimination in UK Biobank was best for the Lung Cancer Death Risk Assessment Tool (LCDRAT, AUC = 0.82, 95% CI = 0.81-0.84), followed by the LCRAT (AUC = 0.81, 95% CI = 0.79-0.82) and the Bach model (AUC = 0.80, 95% CI = 0.79-0.81). Results were similar in EPIC-UK and the Generations Study. All models overestimated risk in all cohorts, with E/O in UK Biobank ranging from 1.20 for LLPv3 (95% CI = 1.14-1.27) to 2.16 for LLPv2 (95% CI = 2.05-2.28). Overestimation increased with area-level socioeconomic status. In the combined cohorts, USPSTF 2013 criteria classified 50.7% of future cases as screening eligible. The LCDRAT and LCRAT identified 60.9%, followed by PLCOm2012 (58.3%), Bach (58.0%), LLPv3 (56.6%), and LLPv2 (53.7%). CONCLUSION: In UK cohorts, the ability of risk prediction models to classify future lung cancer cases as eligible for screening was best for LCDRAT/LCRAT, very good for PLCOm2012, and lowest for LLPv2. Our results highlight the importance of validating prediction tools in specific countries.

Citation

British journal of cancer, 2021, 124 (12), pp. 2026 - 2034

DOI

10.1038/s41416-021-01278-0

URI

https://repository.icr.ac.uk/handle/internal/4633

Rights

https://creativecommons.org/licenses/by/4.0

Source Title

Publisher

SPRINGERNATURE

ISSN

0007-0920

eISSN

1532-1827

Collections

Breast Cancer Research
Genetics and Epidemiology

Research Team

Aetiological Epidemiology
Aetiological Epidemiology

Notes