Performance of smoking duration-based lung cancer screening eligibility criteria: a comparative modeling study

Abstract Background Replacing the pack-year criterion for lung cancer screening with smoking duration has been proposed to reduce racial disparities in eligibility. However, no studies have evaluated the potential long-term benefits and harms of Duration-based criteria. We conducted a comparative modeling study to evaluate the effectiveness of Duration-based eligibility versus that from current guidelines and other alternative criteria. Methods We used three CISNET models to evaluate the performance of Duration-based screening with various smoking duration thresholds (15-40 years in 5-year increments) for the 1960 and 1970 US birth cohorts. We first examined age-specific eligibility patterns of Duration-based strategies versus pack-year and risk-based criteria. We then evaluated the performance of different strategies, comparing the resulting number of screens, lung cancer deaths averted (LCDA), life-years gained (LYG), false-positive screens, and overdiagnosed cases. We compared the strategies’ efficiency using LCDA and LYG per screen and the benefit-to-harm ratios using LCDA and LYG per overdiagnosed case. Results Risk-based criteria resulted in the most LCDA and LYG but also in more overdiagnosed cases. Duration-based strategies with a 35-year cut-off achieved comparable LCDA and LYG to current US guidelines and resulted in similar false positive and overdiagnosed cases per screen. Duration-based scenarios with a 20-year cut-off required substantially more screenings but yielded only modest additional LCDA and LYG, resulting in lower benefits per screen than current guidelines. Conclusion Duration-based screening may be as efficient as current US guidelines. Given their potential to reduce disparities in eligibility shown in recent studies and simpler implementation, Duration-based criteria warrant consideration.