What question did this study set out to answer?

This research aims to assess how well traditional screening criteria and risk prediction models identify high-risk individuals for lung cancer screening.

February 26, 2026Open Access

Improving Lung Cancer Screening Selection: A Comparative Analysis of Risk Models and Traditional Criteria in a Western European General Population

Key Points

This research aims to assess how well traditional screening criteria and risk prediction models identify high-risk individuals for lung cancer screening.
Analyzed baseline data from the Dutch Lifelines cohort (2006-2013) linked to cancer registry data.
Estimated 5-year lung cancer risk using traditional criteria and several risk prediction models.
Calculated eligibility and lung cancer case distribution among eligible and ineligible participants.
From 139,120 participants, 218 developed lung cancer within five years.
Traditional criteria identified 2161-6295 eligible participants, with 62-92 being lung cancer cases.
Risk models identified 2372-4315 eligible participants, with 40-85 being lung cancer cases.
A significant percentage of lung cancers in ineligible groups occurred in individuals who smoked or were under 50.

Abstract

Background/Objectives: The objective of this study is to evaluate the performance of the traditional age/smoking criteria and existing risk prediction models in selecting high-risk populations for lung cancer screening from a Western European general population. Methods: Baseline data from the Dutch population-based Lifelines cohort, collected between 2006 and 2013, were linked to the Dutch cancer registry to confirm lung cancer diagnoses. Five-year lung cancer risk was estimated based on traditional age/smoking criteria (NLST, NELSON, SPSTF-2021) and risk prediction models (LLPv2, PLCOm2012, Hoggart, Bach and Shanghai-LCM). For every strategy, the number of individuals eligible was determined, and total lung cancer cases in the eligible groups versus the ineligible groups were calculated. Results: Among 139,120 participants (aged ≥18 years), 218 (0.2%) developed lung cancer within five years. Age/smoking criteria identified 2161–6295 (1.6–4.5%) participants as eligible, comprising 62–92 (28.4–42.2%) lung cancer cases. Risk prediction models identified 2372–4315 (1.7–3.1%) participants as eligible, comprising 40–85 (18.4–38.9%) lung cancer cases. Among lung cancers in ineligible groups, 46.2–59.6% occurred in individuals who formerly smoked, and 28.7–39.3% occurred in individuals who currently smoke. Additionally, 41.2–70.0% of lung cancer cases in ineligible groups were in individuals younger than 50, and 44.3–72.3% in individuals who had quit smoking > 15 years prior to diagnosis. Conclusions: In a Western European population, current lung cancer screening selection criteria resulted in identifying only 18–42% of lung cancer cases. Cases in ineligible groups predominantly concern individuals who currently smoke and are below the threshold age and individuals who quit smoking > 15 years ago, highlighting the opportunity for more personalized risk-based screening strategies to increase lung cancer detection.

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