Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Comparing the utility of PLCOm2012 and the USPSTF2021 criteria in selecting high-risk individuals for lung cancer screening in the NSW cohort of the International lung Screening Trial (ILST) (#99)

Xinxin Hu 1 , Katrina Tonga 1 2 3 , Christopher Rofe 4 , Kwun Fong 5 6 , Henry Marshall 5 6 , Fraser Brims 7 8 , Annette McWilliams 9 10 , Renee Manser 11 12 13 , Brad Milner 14 , Emily Stone 1 3
  1. Department of Thoracic Medicine , St Vincent's Hospital, Sydney, New South Wales , Australia
  2. The University of Sydney , Sydney, NSW, Australia
  3. The University of New South Wales, Sydney, New South Wales, Australia
  4. Sydney Children's Hospital , Sydney, New South Wales, Australia
  5. Thoracic Research Centre and Department of Thoracic Medicine , The Prince Charles Hospital, Brisbane, Queensland, Australia
  6. The University of Queensland, Brisbane, Queensland, Australia
  7. Department of Respiratory Medicine , Sir Charles Gairdner Hospital, Perth, Western Australia
  8. Curtin Medical School, Curtin University, Bentley, Western Australia , Australia
  9. Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia , Australia
  10. The University of Western Australia , Perth, Western Australia , Australia
  11. Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne , Victoria, Australia
  12. Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
  13. Department of Internal Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  14. Department of Medical Imaging, St Vincent's Hospital, Sydney, New South Wales, Australia

Introduction and aim: The Australian lung cancer screening program using low-dose CT chest is due to commence in 2025.  The aim of this study was to compare the utility of categorical selection criteria (United States Preventative Services Task Force USPSTF2021) and a risk calculation model (PLCOm2012) in identifying high-risk patients for lung cancer screening.

Methods: We compared the screening eligibility of applicants in the NSW cohort of the International Lung Screening Trial (ILST) according to USPSTF2021 and PLCOm2012 (1.5%/6 years) criteria. We also compared the calculated lung cancer risk using the PLCOm2012 model and risk factor profiles of eligible applicants by each criteria.  All variables were reported as mean+/-standard deviation and number (percentage).  Statistical analysis was completed using the Mann-Whitney, McNemar and Chi-squared tests. A p-value<0.05 was deemed significant.

Results: The NSW ILST cohort had 926 applicants. All were assessed by PLCOm2012 (risk calculation) and USPSTF2021 (categorical) criteria. The PLCOm2012 criteria selected fewer candidates than USPSTF2021 (54% vs 59%, p=0.002) but selected those with higher calculated risk than USPSTF2021 (4.94±4.24%/6yrs vs 4.35±4.33%/6yrs, p<0.001). Compared with USPSTF2021, candidates eligible via PLCOm2012 were older (66±6yrs vs 64±6yrs, p<0.001), had higher smoking pack-years (49±22 vs 46±21, p=0.002) and more likely to have a family history of lung cancer (28% vs 21%, p=0.011). Sixty-nine applicants were eligible via PLCOm2012 criteria but excluded by the USPSTF2021 criteria. These applicants had similar calculated lung cancer risk (3.16±1.43%/6yrs vs 4.35±4.33%/6yrs, p=0.956), were older (71±5yrs vs 64±6 yrs, p<0.001), had similar number of smoking pack-years (48±28 vs 46±21, p=0.853) and were more likely to have a family history of lung cancer (51% vs 21%, p<0.001) compared to applicants selected by the USPSTF2021 criteria.  

Conclusion: Selection of high-risk lung cancer screening candidates via USPSTF2021 categorical criteria may exclude candidates eligible via risk calculation with family history of lung cancer.