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Iakovos Toumazis
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P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-03 - Disparities and National Lung Cancer Screening Guidelines in the U.S. Population (ID 1496)
09:45 - 18:00 | Author(s): Iakovos Toumazis
- Abstract
Background
Current U.S. Preventive Services Task Force (USPSTF) lung cancer (LC) screening guidelines are based on smoking history and age (55-80). These guidelines may miss those at higher risk, even at younger ages, due to other risk factors such as race or family history. In this study, we characterize the demographic/clinical profiles of those who are selected by risk-based screening criteria, but missed by USPSTF in younger (45-54) or older ages (71-80).
Method
We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and logistic prediction models for non-smoking risk factors to simulate life-time LC risk-factor data for 100,000 men and women in the U.S. 1950-1960 birth cohorts. We calculated age-specific 6-year LC risk (r) for each individual from ages 45-90 using the PLCOm2012 model. We evaluated age-specific screening-eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3%-2.5%).
Result
In the 1950 cohort, 6.73% would be missed for screening in their younger ages by the USPSTF-criteria, but would have been screened by the risk-based criteria. Similarly, 13.97% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, a higher proportion of African Americans will be ineligible for screening by USPSTF at younger (25.6%) or older (19.7%) ages, which is significantly higher than for Whites (7.7% and 15.75% respectively). Similar results were observed for other risk thresholds and for the 1960 cohort.
Conclusion
Further consideration is needed to incorporate comprehensive risk factors, including race/ethnicity, into lung screening criteria to reduce potential racial disparities.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-02 - Individualized Risk-Based Lung Cancer Screening Incorporating Past Screening Findings and Changes in Smoking Behaviors (ID 1468)
10:15 - 18:15 | Presenting Author(s): Iakovos Toumazis
- Abstract
Background
Risk-based lung cancer screening guidelines are actively being pursued as an alternative to existing guidelines. However, current risk-based approaches do not capture the dynamic nature of the risk and ignore information collected from past screening findings.
Method
We develop and apply a novel decision tool, the Individualized Lung Screening Scheduler (ILungSS), to optimize lung cancer screening for asymptomatic ever-smoked individuals by maximizing the expected quality-adjusted life years (QALYs) gained from screening. The ILungSS models health progression and smoking behavior of US ever-smokers as a dynamic and stochastic process using a partially observable Markov decision process (POMDP). A POMDP is typically used to model sequential decision making under uncertainty and provides a well-suited framework to optimize screening decisions. Screening decisions are based on the personal lung cancer risk of individuals, which is updated leveraging on information obtained from past screening exams and changes in smoking behaviors.
Result
The ILungSS offers personalized optimal screening policies for ever smoked individuals that include the optimal screening starting and stopping ages, and screening frequency. The ILungSS offers fully dynamic screening policies and age-specific risk thresholds that define screening eligibility. The ILungSS yields higher QALYs and lung cancer-specific mortality reduction, recommends extending screening coverage to current light smokers but increases the number of screening exams as compared to the US Preventive Services Task Force (USPSTF) strategy. Upon smoking cessation, the ILungSS adjusts future screening decisions recommending less screens as compared to the USPSTF guidelines. The clear presentation of the health benefits associated with smoking cessation, in terms of personal lung cancer risk and number of recommended future screening exams, could support a smoking cessation program supplementing screening.
Conclusion
Personalized, dynamic risk-based lung cancer screening could improve the effectiveness of lung cancer screening. The ILungSS integrates screening with a smoking cessation program that could further improve the effectiveness of screening.
