Performance of smoking duration-based lung cancer screening eligibility criteria: a comparative modeling study
Menée aux Etats-Unis à l'aide d'une modélisation, cette étude évalue la performance, du point de vue du nombre d'examens diagnostiques réalisés, du nombre de décès par cancer du poumon évités, du nombre d'années de vie gagnées (LYG) et du nombre de cas faussement positifs, de stratégies de dépistage avec critères d'éligibilité basés sur la durée du tabagisme par rapport à des stratégies de dépistage avec critères d'éligibilité basés sur le nombre de paquets consommés par an
Background : Replacing the pack-year criterion for lung cancer screening with smoking duration has been proposed to reduce racial disparities in eligibility. However, no studies have evaluated the potential long-term benefits and harms of Duration-based criteria. We conducted a comparative modeling study to evaluate the effectiveness of Duration-based eligibility versus that from current guidelines and other alternative criteria.
Methods : We used three CISNET models to evaluate the performance of Duration-based screening with various smoking duration thresholds (15-40 years in 5-year increments) for the 1960 and 1970 US birth cohorts. We first examined age-specific eligibility patterns of Duration-based strategies versus pack-year and risk-based criteria. We then evaluated the performance of different strategies, comparing the resulting number of screens, lung cancer deaths averted (LCDA), life-years gained (LYG), false-positive screens, and overdiagnosed cases. We compared the strategies’ efficiency using LCDA and LYG per screen and the benefit-to-harm ratios using LCDA and LYG per overdiagnosed case.
Results : Risk-based criteria resulted in the most LCDA and LYG but also in more overdiagnosed cases. Duration-based strategies with a 35-year cut-off achieved comparable LCDA and LYG to current US guidelines and resulted in similar false positive and overdiagnosed cases per screen. Duration-based scenarios with a 20-year cut-off required substantially more screenings but yielded only modest additional LCDA and LYG, resulting in lower benefits per screen than current guidelines.
Conclusion : Duration-based screening may be as efficient as current US guidelines. Given their potential to reduce disparities in eligibility shown in recent studies and simpler implementation, Duration-based criteria warrant consideration.
Journal of the National Cancer Institute , article en libre accès, 2026