Predicting lung cancer occurrence in never-smoking females in Asia: TNSF-SQ, a prediction model

Background: High disease burden suggests the desirability to identify high-risk Asian never-smoking females (NSFs) who may benefit from low-dose computed tomography (LDCT) screening. In North America, one is eligible for LDCT screening if one satisfies the U.S. Preventive Services Task Force (USPSTF) criteria or has model-estimated six-year risk >0.0151. According to two US reports, only 36.6% female lung cancer patients met the USPSTF criteria, while 38% of the ever-smokers aged 55-74 met the USPSTF criteria. Methods: Using data on NSFs in the Taiwan Genetic Epidemiology Study of Lung Adenocarcinoma and the Taiwan Biobank before August 2016, we formed an age-matched case-control study, consisting of 1748 lung cancer patients and 6535 controls. Using these and an estimated age-specific lung cancer six-year incidence rate among Taiwanese NSFs, we developed the Taiwanese NSF Lung Cancer Risk Models using genetic information and simplified questionnaire (TNSF-SQ). Performance evaluation was based on the newer independent datasets: Taiwan Lung Cancer Pharmacogenomics Study (LCPG) and Taiwan Biobank data after August 2016 (TWB2). Results: The AUC based on the NSFs aged 55-70 in LCPG and TWB2 was 0.714 (95% CI 0.660, 0.768). For women in TWB2 aged 55-70, 3.94% (95% CI 2.95, 5.13) had risk higher than 0.0151. For women in LCPG aged 55-74, 27.03% (95% CI 19.04, 36.28) had risk higher than 0.0151. Conclusions: TNSF-SQ demonstrated good discriminative power. The ability to identify 27.03% of high risk Asian NSFs aged 55-74 deserves attention. Impact: TNSF-SQ seems potentially useful in selecting Asian NSFs for LDCT screening.