Selection of eligible participants for screening for lung cancer using primary care data

O’Dowd, Emma L.; Ten Haaf, Kevin; Kaur, Jaspreet; Duffy, Stephen W.; Hamilton, William; Hubbard, Richard B.; Field, John K.; Callister, Matthew E.; Janes, Sam M.; de Koning, Harry; Rawlinson, Janette; Baldwin, David R.

Abstract

Lung cancer screening is effective if offered to people at increased risk of the disease. Currently, direct contact with potential participants is required for evaluating risk. A way to reduce the number of ineligible people contacted might be to apply risk-prediction models directly to digital primary care data, but model performance in this setting is unknown. METHOD: The Clinical Practice Research Datalink, a computerised, longitudinal primary care database, was used to evaluate the Liverpool Lung Project V.2 (LLPv2) and Prostate Lung Colorectal and Ovarian (modified 2012) (PLCOm2012) models. Lung cancer occurrence over 5-6 years was measured in ever-smokers aged 50-80 years and compared with 5-year (LLPv2) and 6-year (PLCOm2012) predicted risk. RESULTS: Over 5 and 6 years, 7123 and 7876 lung cancers occurred, respectively, from a cohort of 842 109 ever-smokers. After recalibration, LLPV2 produced a c-statistic of 0.700 (0.694-0.710), but mean predicted risk was over-estimated (predicted: 4.61%, actual: 0.9%). PLCOm2012 showed similar performance (c-statistic: 0.679 (0.673-0.685), predicted risk: 3.76%. Applying risk-thresholds of 1% (LLPv2) and 0.15% (PLCOm2012), would avoid contacting 42.7% and 27.4% of ever-smokers who did not develop lung cancer for screening eligibility assessment, at the cost of missing 15.6% and 11.4% of lung cancers. CONCLUSION: Risk-prediction models showed only moderate discrimination when applied to routinely collected primary care data, which may be explained by quality and completeness of data. However, they may substantially reduce the number of people for initial evaluation of screening eligibility, at the cost of missing some lung cancers. Further work is needed to establish whether newer models have improved performance in primary care data.

Citation

O’Dowd, E. L., Ten Haaf, K., Kaur, J., Duffy, S. W., Hamilton, W., Hubbard, R. B., …Baldwin, D. R. (2022). Selection of eligible participants for screening for lung cancer using primary care data. Thorax, 77(9), 882-890. https://doi.org/10.1136/thoraxjnl-2021-217142

• Journal Article Type: Article
• Acceptance Date: Sep 24, 2021
• Online Publication Date: Oct 29, 2021
• Publication Date: Sep 1, 2022
• Deposit Date: Oct 5, 2021
• Publicly Available Date: Oct 29, 2021
• Journal: Thorax
• Print ISSN: 0040-6376
• Electronic ISSN: 1468-3296
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 77
• Issue: 9
• Pages: 882-890
• DOI: https://doi.org/10.1136/thoraxjnl-2021-217142
• Keywords: Lung Cancer; screening; eligibility; selection criteria
• Public URL: https://nottingham-repository.worktribe.com/output/6391705
• Publisher URL: https://thorax.bmj.com/content/early/2021/10/28/thoraxjnl-2021-217142
• Additional Information: This article has been accepted for publication in Thorax, 2021 following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/thoraxjnl-2021-217142