Model predicts lung cancer risk

Researchers have shown that The Liverpool Lung Project (LLP) Risk Model is effective in identifying those at the highest risk for lung cancer within 5 years, and who are therefore suitable for computed tomography (CT) screening.

The authors say that the model addresses major limitations in current predictive techniques, by combining five risk factors for lung cancer.

"[The LLP Risk Model] unifies smoking duration, other important risk factors for lung cancer, and incidence data from cancer registries, thereby combining the benefit of each to provide accurate and diverse predicted risks for smokers and nonsmokers," write John Field (University of Liverpool, UK) and colleagues in the Annals of Internal Medicine.

The authors used two independent case-control studies and a population-based prospective cohort study to validate their model. These included questionnaire data from 12,397 participants, with and without lung cancer. From the questionnaires, they extracted information on the five risk factors in the model - smoking duration, history of pneumonia, history of cancer, family history of cancer, and asbestos exposure.

They found that in a decision utility analysis, the LLP Risk Model had a higher ability to discriminate risk across all three data sets than smoking duration or family history of cancer alone.

Furthermore, at thresholds of absolute risk ranging from 3% to 15%, the LLP Risk model provided greater net benefit than the alternative strategies of using smoking duration or family history, and screening everyone or screening no one.

Importantly, their modeling techniques incorporate the relative risks and benefits of CT screening. "Assessing the potential clinical application of a risk model is an important part of validation because it illustrates the potential benefits and harms based on the predicted absolute risk," say the authors.

They say that while their study shows the utility of the tool, prospective evaluation of the model is required before it can be used in a clinical setting.

"The potential for lung cancer screening programmes is now a major focus of ongoing UK and international clinical screening trials which potentially could be instigated in Europe within the next three years," said Field in a press release, who added: "The validation of the LLP Risk Model now provides the community with a powerful tool for the selection of future patients into such screening programmes."

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