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Assessing Benefit of lung Cancer Screening CT Beyond NLST Criteria
Carlos E. Bravo*; Katherine W. Armstrong; Michael T. Jaklitsch; Francine L. Jacobson
Brigham and Women's Hospital, Boston, MA

Background: The National Lung Screening Trial (NLST) showed that low-dose computed tomography (LDCT) reduces lung cancer-specific mortality by 20%. Increasing sophistication in assessing pre-test probability of cancer will minimize screening risk.

Methods: The Liverpool Lung Project (LLP) and The Prostate, Lung, Colorectal and Ovarian (PLCO) risk prediction models estimate the probability of developing lung cancer within 5-9 years. Factors include: age, sex, smoking history, family history of lung cancer, occupational/environmental exposures, and prior malignancy. Using these models, we calculated risk as a function of age for pre-set variables to examine trends.

Results: We plotted risk profiles for current smokers (30 pack-years), average BMI 26, high school education and no personal history of cancer. Familial history was assigned by first degree relative age at diagnosis of lung cancer: early (if 60 years), or no first degree relative. Significant risk with increasing age was predicted in the PLCO database for 30 pack year smokers having a relative with cancer (any age), 30 pack year smokers without a relative with cancer, and in the LLP database for men with 30 pack year smoking and a relative with early onset.

Conclusion: Individual risk assessment can be judged using large databases, including PLCO and LLP. Use of this individual risk assessment for patients over 65 years of age may identify appropriate screening populations not included in current recommendations.

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