Personalizing lung cancer screening recommendations for heterogenous populations: a microsimulation study
Menée à l'aide d'une microsimulation simulant une population américaine de 59 millions d'adultes fumeurs âgés de 40 à 80 ans, cette étude estime, parmi les personnes éligibles actuellement au dépistage du cancer du poumon (selon les recommandations de l'"United States Preventive Services Task Force"), la proportion d'entre elles pour laquelle le dépistage serait réellement bénéfique (en termes d'années de vie sauvées) et pourrait être encouragé
Background : There is little guidance on how to personalize recommendations for lung cancer screening (LCS) that accounts for the variation in expected net benefit from LCS. We sought to explore the individual and population implications of identifying net benefit thresholds where LCS could be encouraged, discouraged, or offered as an option through neutral shared decision making due to being highly preference sensitive.
Methods : Using a simulated US population of 40-80yos who have ever smoked, we used microsimulation to estimate individualized quality-adjusted life years saved with LCS. We then identified two net benefit thresholds for LCS that account for a range of patient preferences and scientific uncertainties and compared this approach to current United States Preventive Services Task Force (USPSTF) guidelines.
Results : Our simulated population included 59 million. 15 million are USPSTF eligible and of those, 52% (8 million) maintain net benefit even after accounting for unfavorable preferences about screening. 3% (450,000) of the USPSTF population is considered low-net-benefit (routinely discourage) and 45% (7 million) are in an intermediate gray area where net benefit is dependent upon patient preferences about LCS (offer neutral SDM). 2.5 million ever-smoking adults are high-net-benefit but excluded by current USPSTF criteria. 20.5 million ever-smoking U.S. adults are intermediate-net-benefit but are currently excluded by USPSTF criteria.
Conclusion : We estimate that half of the USPSTF LCS-eligible population is in a high net-benefit group where LCS could be routinely encouraged. Current LCS eligibility criteria likely exclude many ever-smokers who are high-net-benefit and many more with intermediate net benefit.
Journal of the National Cancer Institute , article en libre accès, 2025