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Rafael Meza

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    WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)

    • Event: WCLC 2017
    • Type: Workshop
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      WS 01.07 - Modeling Smoking Trends and CT Screening to 2060 (ID 10645)

      08:30 - 21:00  |  Presenting Author(s): Rafael Meza

      • Abstract

      Modeling smoking trends and lung cancer screening to 2060 in the US; changes in screening eligibility and the potential impact of joint screening and cessation programs on smoking and lung cancer. Introduction. Annual lung cancer screening with low-dose computed tomography (LDCT) has been recommended in the US for current and former smokers with ≥30 pack-years of exposure and ≤15 years. Since about 50% of eligible individuals are current smokers, the implementation of lung cancer screening programs presents a unique opportunity to develop cessation programs targeting high-risk individuals at the point of screening. Despite its potential, since screening eligibility is based on cumulative smoking exposure, the continuing decreases in smoking in the US should lead to reductions in the number of screening-eligible individuals reducing the potential impact of screening and of cessation programs within lung cancer screening. It is thus important to investigate the possible interplay that screening and smoking cessation will have in short and long-term tobacco and lung cancer outcomes. Methods. We used a previously validated smoking and lung cancer microsimulation natural history model and census population forecasts to project smoking trends, the number and percentage of individuals eligible for screening, and the potential costs of screening in the US from 2015-2060. We then used the model to project the impact that hypothetical cessation programs within the context of lung cancer screening with varying efficacy could have on smoking, lung cancer and overall mortality. Results. We found that given current smoking prevalence and cessation trends, the number and percentage of screening-eligible individuals in the US will decrease dramatically in the next few decades, reaching under 5 million by 2035, and that the potential costs associated to lung cancer screening will decrease considerably as fewer individuals satisfy current eligibility criteria. Preliminary simulations of cessation interventions targeting smokers considering (or receiving) lung cancer screening, suggest that effective cessation programs within lung cancer screening could have significant benefits and lead to considerable reductions in lung cancer and overall tobacco-related mortality. For example, under a 40% lung cancer screening uptake scenario, the model predicts that a smoking cessation program with a 10% success rate would lead to 160,000 fewer lung cancer deaths, and 1.4 million life years gained by 2060. Conclusions. Although the number of lung cancer screening eligible individuals in the US is expected to decrease considerably in the next decades, effective cessation interventions within the context of lung cancer screening have the potential to greatly enhance the impact of screening programs and lead to considerable reductions in lung cancer mortality and tobacco-related diseases. Figure 1 Figure 1. Projected life-years gained from lung cancer screening and a one-time cessation intervention within the context of lung cancer screening for different values of the probability of cessation due to the intervention. The projections consider the dynamical changes in population structure, smoking prevalence and screening eligibility, and assume that 60% of screening-eligible individuals would be screened and that all screened smokers receive the cessation intervention after receiving their first screen.