Prediction of Lung Cancer Screening Eligibility Using Simplified Criteria

Rationale: Lung cancer screening with low-dose chest computed tomography decreases mortality for high-risk current or former smokers. Lifetime smoking intensity (cigarette pack-years), an essential eligibility criterion, is poorly recorded in electronic health records, which may contribute to the overall low appropriate use of screening. Objectives: We sought to assess whether elements commonly extractable from electronic health records may be useful as prescreening tools to identify individuals for formal assessment of eligibility. Methods: This was a cross-sectional cohort study of the National Health and Nutrition Examination Survey (NHANES) continuous survey, years 2011-2016. We included all adult participants with complete smoking interview data, weighted to construct a nationally representative cohort. We determined test characteristics for five criteria, including eligibility age, smoking status (current, former, or never), and current smoking intensity, to predict lung cancer screening eligibility as defined by the U.S. Preventive Services Task Force and Centers for Medicare and Medicaid Services. Results: Almost 9 million individuals (3.8% of the population) may qualify for screening. Simplified criteria, including the appropriate age range (55-77 yr) and smoking status, correctly discriminated individuals who were eligible for screening in most cases (area under the curve = 0.92). When the analysis was restricted to those of eligible age, smoking status retained fair predictive value (area under the curve = 0.85). Incorporating additional information about current smoking behavior would allow for refinement of approaches to identify specific populations for screening. Conclusions: These simplified criteria may be useful for identifying individuals who are eligible for lung cancer screening. Applying these criteria as a prescreening tool may improve appropriate referral and implementation of screening.