Prospective evaluation of lung cancer screening eligibility criteria and lung cancer detection in the Yorkshire Lung Screening Trial

Introduction: Low dose CT (LDCT) screening for lung cancer reduces lung cancer mortality, but there is a lack of international consensus regarding the optimal eligibility criteria for screening. The Yorkshire Lung Screening Trial (YLST) was designed to evaluate lung cancer screening (LCS) implementation and a primary objective was prospective evaluation of 3 pre-defined eligibility criteria.

Methods: Individuals who had ever smoked, aged 55-80yrs, who responded to written invitation, underwent telephone risk assessment and if eligible by at least one criteria (PLCO_M2012≥1.51%, LLP_v2≥5%, USPSTF₂₀₁₃) were offered biennial LDCT screening.

Results: Of 44,957 individuals invited, 22,814 responded and underwent eligibility assessment, of whom a total of 7,826 were eligible according to any of the three LCS criteria. Comparing PLCO_M2012≥1.51%, LLP_v2≥5%, and USPSTF₂₀₁₃, the proportions of responders eligible for screening were 28.0%, 20.5% and 18.9% respectively (p<0.0001 for each comparison), and the proportion of all cancers detected 91.1%, 77.0%, and 62.8% respectively (p≤0.0002 for each comparison). When risk thresholds were selected to result in equivalent numbers of people eligible for screening, cancer detection proportions were higher for PLCO_M2012 (74.5%) and LLP_v2 (71.3%) than USPSTF₂₀₁₃ (62.8%) (p=0.0002 and p=0.032 respectively) but there was no significant difference between the two risk models. Reducing the LLPv2 risk threshold from 5% to 2.5% (as currently used in the English lung cancer screening programme) and reducing the pack-year requirement for the USPSTF2021 vs the USPSTF2013 criteria increased the numbers eligible for screening, but subsequent cancer yield was not measured in this study.

Conclusion: The PLCO_M2012≥1.51% criteria identified more people eligible for screening in YLST and resulted in more screen-detected lung cancers than LLP_v2≥5% or USPSTF₂₀₁₃. When compared in equivalent populations, there was no significant difference between risk models in terms of lung cancer detection and each appeared more efficient at screening population selection than USPSTF₂₀₁₃.