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

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    Authors
    Robbins H A
    Alcala K
    Swerdlow A J
    Schoemaker M J
    Wareham N
    Travis R C
    Crosbie Philip A J
    Callister M
    Baldwin D R
    Landy R
    Johansson M
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    Affiliation
    International Agency for Research on Cancer, Lyon, France.
    Issue Date
    2021
    
    Metadata
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    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
    Robbins HA, Alcala K, Swerdlow AJ, Schoemaker MJ, Wareham N, Travis RC, et al. Comparative performance of lung cancer risk models to define lung screening eligibility in the United Kingdom. Br J Cancer. 2021 Apr 12;124(12):2026–34.
    Journal
    British Journal of Cancer
    URI
    http://hdl.handle.net/10541/624139
    DOI
    10.1038/s41416-021-01278-0
    PubMed ID
    33846525
    Additional Links
    https://dx.doi.org/10.1038/s41416-021-01278-0
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1038/s41416-021-01278-0
    Scopus Count
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    All Paterson Institute for Cancer Research

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