Eligibility criteria for lung cancer screening in France: a modelling study

Abstract

Background

We estimated the potential impact of different eligibility criteria for lung cancer screening in France, to inform a planned national pilot program.

Methods

We simulated the French population by integrating national population estimates and smoking prevalence with lung cancer risk factors from the CONSTANCES cohort. We predicted lung cancer cases and deaths using the Lung Cancer [Death] Risk Assessment Tool for individuals with a smoking history. We evaluated four screening eligibility strategies: the US Preventive Services Task Force criteria (USPSTF) 2013, USPSTF-2021, NELSON, and a risk-based strategy (PLCOm2012 model).

Findings

We simulated 14,860,000 individuals with a smoking history aged 50–80 years in France. We estimated 11,000–14,000 preventable lung cancer deaths over 5 years by screening 2.4–4.0 million individuals, depending on eligibility criteria. When screening the same number of individuals, we estimated the risk-based strategy would identify an additional 12–22% preventable lung cancer deaths compared with categorical criteria. Individuals selected by risk-based criteria were typically 5–7 years older, with 4–6 years shorter life expectancy, but categorical criteria selected many individuals with low anticipated screening benefit (33% among USPSTF-2021-eligible). Restricting to individuals aged 50–74, 55–80, and 55–74 years gave smaller differences between categorical and risk-based criteria in age (2–6 years difference), life expectancy (2–5 years difference), and preventable lung cancer deaths (6–17% difference).

Interpretation

Screening high-risk individuals for lung cancer might prevent over 10,000 lung cancer deaths in France over 5 years, with potentially higher efficiency for risk-based eligibility compared with categorical criteria.

Funding

l’Institut National du Cancer.