Analysis of lung cancer risk model (PLCO(M2012)and LLPv2) performance in a community-based lung cancer screening programme

Introduction Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCO(M2012)and Liverpool Lung Project model (LLPv2)) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme. Methods Ever-smokers aged 55-74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCO(M2012)score >= 1.51%) were offered annual LDCT screening over two rounds. LLP(v2)score was calculated but not used for screening selection; >= 2.5% and >= 5% thresholds were used for analysis. Results PLCOM2012 >= 1.51% selected 56% (n=1429) of LHC attendees for screening. LLPv2 >= 2.5% also selected 56% (n=1430) whereas NLST (47%, n=1188) and LLPv2 >= 5% (33%, n=826) selected fewer. Over two screening rounds 62 individuals were diagnosed with LC; representing 87% (n=62/71) of 6-year incidence predicted by mean PLCO(M2012)score (5.0%). 26% (n=16/62) of individuals with LC were not eligible for screening using LLPv2 >= 5%, 18% (n=11/62) with NLST criteria and 7% (n=5/62) with LLPv2 >= 2.5%. NLST eligible Manchester attendees had 2.5 times the LC detection rate than NLST participants after two annual screens (approximate to 4.3% (n=51/1188) vs 1.7% (n=438/26 309); p