Lung Cancer Screening May Be More Cost-Effective When Using Risk Model–Based Strategies

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Risk model–based lung cancer screening strategies may be more cost-effective than current recommendations that are based solely on the patient’s age and smoking history, according to a new study published by Toumazis et al in the Annals of Internal Medicine. The findings also suggested that incorporating models of personal lung cancer risk should be considered for future recommendations by the U.S. Preventive Services Task Force (USPSTF).


Lung cancer is the leading cause of cancer death in the United States, and the second most common cancer diagnosed annually, according to the American Cancer Society. The USPSTF’s current recommendations call for annual low-dose computed tomography (CT) scans for adults aged 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or have quit within the past 15 years.

“Findings from this study could be considered as a potential guide for the development of cost-effective risk model–based lung cancer screenings under various settings and availability of health-care resources,” said lead study author Iakovos Toumazis, PhD, Assistant Professor of Health Services Research in the Division of Cancer Prevention and Population Sciences at The University of Texas MD Anderson Cancer Center. “While the current recommendations are cost-effective, our findings suggest that we can improve on these guidelines and provide more flexibility to include those most likely to benefit from lung cancer screenings,” he added.

Study Methods and Results

In the new study, the investigators analyzed two different risk calculator models—the first estimating an individual’s 6-year risk of developing lung cancer, and the second predicting an individual’s 6-year risk of dying from the disease. They simplified both models to consider only age, sex, and smoking-related risk factors.

The investigators found that risk model–based screenings may be cost-effective regardless of which calculator was used, but also emphasized the importance of selecting a risk threshold specific to the calculator. Additionally, the investigators identified a range of risk thresholds that, when used to select individuals for screenings, yielded more quality-adjusted life years and cost savings relative to current USPSTF recommendations under various assumptions.


“Our model shows that personal risk–based screenings for lung cancer [may be] cost-effective under a wide range of risk thresholds, offering flexibility for implementing risk model–based approaches in a variety of settings that have different health-care resources available,” Dr. Toumazis concluded.

Disclosure: The research in this study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit

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