Performance of Risk factor-based Guidelines and Model-based Chest CT Lung Cancer Screening in World Trade Center Exposed Fire Department Rescue/Recovery Workers.

Abstract Background Lung cancer is a leading cause of cancer incidence and death in the US. Risk factor-based guidelines and risk model-based strategies are used to identify patients who could benefit from LDCT screening. Few studies compare guidelines/models within the same cohort. We evaluate lung cancer screening performance of two risk factor-based guidelines (US Preventive Services Task Force 2014 recommendations [USPSTF-2014] and National Comprehensive Cancer Network Group 2 [NCCN-2]) and two risk model-based strategies PLCOm2012 and Bach model) in the same occupational cohort. Research Question Which risk factor-based guideline or model-based strategy is most accurate in detecting lung cancers in a highly exposed occupational cohort? Study Design and Methods : Fire Department of New York City (FDNY) rescue/recovery workers exposed to the 9/11/2001 attacks underwent LDCT lung cancer screening based on smoking history and age. The USPSTF-2014, NCCN-2, PLCOm2012 model and Bach model were retrospectively applied to determine how many lung cancers were diagnosed using each approach. Results Among the study population (N=3,953), 930 underwent a baseline scan that met at least one risk-factor or model-based LDCT screening strategy; 74% received follow-up annual scans. Among the 3,953, 63 lung cancers were diagnosed of which 50 were detected by at least one LDCT screening strategy. The NCCN-2 guideline was the most sensitive (79.4%; 50/63). When compared to NCCN-2, stricter age and smoking criteria reduced sensitivity of the other guidelines/models (USPSTF-2014[44%], PLCOm2012[51%] and Bach[46%]). The 13 missed lung cancers were mainly due to smoking less and quitting longer than guideline/model eligibility criteria. False-positive rates were similar across all four guidelines/models. Interpretation In this cohort, our findings support expanding eligibility for LDCT lung cancer screening by lowering smoking history from ≥30 to ≥20 pack-years and age from 55-years to 50-years old. Additional studies are needed to determine its generalizability to other occupational/environmental exposed cohorts.