ArticleJournal of the National Cancer Institute2026
Performance of smoking duration-based lung cancer screening eligibility criteria: a comparative modeling study.
Article in Journal of the National Cancer Institute, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundReplacing the pack-year criterion for lung cancer screening with smoking duration has been proposed to reduce racial disparities in eligibility. However, no studies have evaluated the potential long-term benefits and harms of duration-based criteria. We conducted a comparative modeling study to evaluate the effectiveness of duration-based eligibility vs that from current guidelines and other alternative criteria.
methodsWe used 3 Cancer Intervention and Surveillance Modeling Network models to evaluate the performance of duration-based screening with various smoking duration thresholds (15-40 years in 5-year increments) for the 1960 and 1970 US birth cohorts. We first examined age-specific eligibility patterns of duration-based strategies vs pack-year and risk-based criteria. We then evaluated the performance of different strategies, comparing the resulting number of screens, lung cancer deaths averted, life-years gained, false-positive screens, and overdiagnosed cases. We compared the strategies' efficiency using lung cancer deaths averted and life-years gained per screen and the benefit-to-harm ratios using lung cancer deaths averted and life-years gained per overdiagnosed case.
resultsRisk-based criteria resulted in the most lung cancer deaths averted and life-years gained but also in more overdiagnosed cases. Duration-based strategies with a 35-year cutoff achieved comparable lung cancer deaths averted and life-years gained to current US guidelines and resulted in similar false-positive and overdiagnosed cases per screen. Duration-based scenarios with a 20-year cutoff required substantially more screenings but yielded only modest additional lung cancer deaths averted and life-years gained, resulting in lower benefits per screen than current guidelines.
conclusionDuration-based screening may be as efficient as current US guidelines. Given their potential to reduce disparities in eligibility shown in recent studies and simpler implementation, duration-based criteria warrant consideration.
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