Rafael Meza1, Pianpian Cao2, Jihyoun Jeon2, Kathryn L Taylor3, Jeanne S Mandelblatt3, Eric J Feuer4, Douglas R Lowy5. 1. Department of Epidemiology, University of Michigan, Ann Arbor, Michigan. Electronic address: rmeza@umich.edu. 2. Department of Epidemiology, University of Michigan, Ann Arbor, Michigan. 3. Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia. 4. Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, Maryland. 5. Office of the Director, National Cancer Institute, Bethesda, Maryland.
Abstract
INTRODUCTION: In 2021, the U.S. Preventive Services Task Force (USPSTF) revised its lung cancer screening recommendations expanding its eligibility. As more smokers become eligible, cessation interventions at the point of screening could enhance the benefits. Here, we evaluate the effects of joint screening and cessation interventions under the new recommendations. METHODS: A validated lung cancer natural history model was used to estimate lifetime number of low-dose computed tomography screens, percentage ever screened, lung cancer deaths, lung cancer deaths averted, and life-years gained for the 1960 U.S. birth cohort aged 45 to 90 years (4.5 million individuals). Screening occurred according to the USPSTF 2013 and 2021 recommendations with varying uptake (0%, 30%, 100%), with or without a cessation intervention at the point of screening with varying effectiveness (15%, 100%). RESULTS: Screening 30% of the eligible population according to the 2021 criteria with no cessation intervention (USPSTF 2021, 30% uptake, without cessation intervention) was estimated to result in 6845 lung cancer deaths averted and 103,725 life-years gained. These represent 28% and 34% increases, respectively, relative to screening according to the 2013 guidelines (USPSTF 2013, 30% uptake, without cessation intervention). Adding a cessation intervention at the time of the first screen with 15% effectiveness (USPSTF 2021, 30% uptake, with cessation intervention with 15% effectiveness) was estimated to result in 2422 additional lung cancer deaths averted (9267 total, ∼73% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 322,785 life-years gained (∼318% increase). Screening 100% of the eligible according to the 2021 guidelines with no cessation intervention (USPSTF 2021, 100% uptake, without cessation intervention) was estimated to result in 23,444 lung cancer deaths averted (∼337% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 354,330 life-years gained (∼359% increase). Adding a cessation intervention with 15% effectiveness (USPSTF 2021, 100% uptake, with cessation intervention with 15% effectiveness) would result in 31,998 lung cancer deaths averted (∼497% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 1,086,840 life-years gained (∼1309% increase). CONCLUSIONS: Joint screening and cessation interventions would result in considerable lung cancer deaths averted and life-years gained. Adding a one-time cessation intervention of modest effectiveness (15%) results in comparable life-years gained as increasing screening uptake from 30% to 100% because while cessation decreases mortality from many causes, screening only reduces lung cancer mortality. This simulation indicates that incorporating cessation programs into screening practice should be a priority as it can maximize overall benefits.
INTRODUCTION: In 2021, the U.S. Preventive Services Task Force (USPSTF) revised its lung cancer screening recommendations expanding its eligibility. As more smokers become eligible, cessation interventions at the point of screening could enhance the benefits. Here, we evaluate the effects of joint screening and cessation interventions under the new recommendations. METHODS: A validated lung cancer natural history model was used to estimate lifetime number of low-dose computed tomography screens, percentage ever screened, lung cancer deaths, lung cancer deaths averted, and life-years gained for the 1960 U.S. birth cohort aged 45 to 90 years (4.5 million individuals). Screening occurred according to the USPSTF 2013 and 2021 recommendations with varying uptake (0%, 30%, 100%), with or without a cessation intervention at the point of screening with varying effectiveness (15%, 100%). RESULTS: Screening 30% of the eligible population according to the 2021 criteria with no cessation intervention (USPSTF 2021, 30% uptake, without cessation intervention) was estimated to result in 6845 lung cancer deaths averted and 103,725 life-years gained. These represent 28% and 34% increases, respectively, relative to screening according to the 2013 guidelines (USPSTF 2013, 30% uptake, without cessation intervention). Adding a cessation intervention at the time of the first screen with 15% effectiveness (USPSTF 2021, 30% uptake, with cessation intervention with 15% effectiveness) was estimated to result in 2422 additional lung cancer deaths averted (9267 total, ∼73% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 322,785 life-years gained (∼318% increase). Screening 100% of the eligible according to the 2021 guidelines with no cessation intervention (USPSTF 2021, 100% uptake, without cessation intervention) was estimated to result in 23,444 lung cancer deaths averted (∼337% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 354,330 life-years gained (∼359% increase). Adding a cessation intervention with 15% effectiveness (USPSTF 2021, 100% uptake, with cessation intervention with 15% effectiveness) would result in 31,998 lung cancer deaths averted (∼497% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 1,086,840 life-years gained (∼1309% increase). CONCLUSIONS: Joint screening and cessation interventions would result in considerable lung cancer deaths averted and life-years gained. Adding a one-time cessation intervention of modest effectiveness (15%) results in comparable life-years gained as increasing screening uptake from 30% to 100% because while cessation decreases mortality from many causes, screening only reduces lung cancer mortality. This simulation indicates that incorporating cessation programs into screening practice should be a priority as it can maximize overall benefits.
Authors: Christopher J Cadham; Jinani C Jayasekera; Shailesh M Advani; Shelby J Fallon; Jennifer L Stephens; Dejana Braithwaite; Jihyoun Jeon; Pianpian Cao; David T Levy; Rafael Meza; Kathryn L Taylor; Jeanne S Mandelblatt Journal: Lung Cancer Date: 2019-07-06 Impact factor: 5.705
Authors: Steven D Criss; Pianpian Cao; Mehrad Bastani; Kevin Ten Haaf; Yufan Chen; Deirdre F Sheehan; Erik F Blom; Iakovos Toumazis; Jihyoun Jeon; Harry J de Koning; Sylvia K Plevritis; Rafael Meza; Chung Yin Kong Journal: Ann Intern Med Date: 2019-11-05 Impact factor: 25.391
Authors: William K Evans; Cindy L Gauvreau; William M Flanagan; Saima Memon; Jean Hai Ein Yong; John R Goffin; Natalie R Fitzgerald; Michael Wolfson; Anthony B Miller Journal: CMAJ Open Date: 2020-09-22
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Authors: Alex H Krist; Karina W Davidson; Carol M Mangione; Michael J Barry; Michael Cabana; Aaron B Caughey; Esa M Davis; Katrina E Donahue; Chyke A Doubeni; Martha Kubik; C Seth Landefeld; Li Li; Gbenga Ogedegbe; Douglas K Owens; Lori Pbert; Michael Silverstein; James Stevermer; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2021-03-09 Impact factor: 56.272
Authors: Kevin Ten Haaf; Mehrad Bastani; Pianpian Cao; Jihyoun Jeon; Iakovos Toumazis; Summer S Han; Sylvia K Plevritis; Erik F Blom; Chung Yin Kong; Martin C Tammemägi; Eric J Feuer; Rafael Meza; Harry J de Koning Journal: J Natl Cancer Inst Date: 2020-05-01 Impact factor: 13.506
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Authors: Pianpian Cao; Laney Smith; Jeanne S Mandelblatt; Jihyoun Jeon; Kathryn L Taylor; Amy Zhao; David T Levy; Randi M Williams; Rafael Meza; Jinani Jayasekera Journal: JNCI Cancer Spectr Date: 2022-07-01