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Estimating eligibility for lung cancer screening in an Australian cohort, including the effect of spirometry

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Lung cancer causes more deaths than any other cancer, and is a leading cause of disease-related burden in Australia.1 The United States National Lung Screening Trial (NLST) showed that screening high risk current and former smokers for lung cancer with low dose chest computed tomography (LDCT) can significantly reduce lung cancer mortality.2 LDCT lung cancer screening is recommended in the US for eligible individuals.3

Unlike other cancer screening programs that select participants according to the risk factors of age and sex, eligibility for lung cancer screening is more complex. The current US screening criteria, as defined by the US Preventive Service Task Force (USPSTF), are that current or former smokers are eligible if they are aged 55–80 years, have a smoking history of at least 30 pack-years, and, if a former smoker, have quit less than 15 years ago.3 However, this approach is not necessarily the most efficient for identifying those who may benefit from screening.4 Using probabilistic multivariate lung cancer risk prediction models to select individuals for screening may improve overall efficiency and cost-effectiveness, and are recommended by international organisations.57