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Lung cancer
‘Reduced’ HUNT model outperforms NLST and NELSON study criteria in predicting lung cancer in the Danish screening trial
  1. Oluf Dimitri Røe1,2,
  2. Maria Markaki3,
  3. Ioannis Tsamardinos3,4,
  4. Vincenzo Lagani5,6,
  5. Olav Toai Duc Nguyen1,2,
  6. Jesper Holst Pedersen7,
  7. Zaigham Saghir8 and
  8. Haseem Gary Ashraf8,9
  1. 1Department of Clinical and Molecular Medicine, Norges teknisk-naturvitenskapelige universitet, Trondheim, Norway
  2. 2Cancer Clinic, Sykehuset Levanger, Levanger, Norway
  3. 3Department of Computer Science, University of Crete - Voutes Campus, Heraklion, Greece
  4. 4Institute of Applied Mathematics, Foundation for Research and Technology - Hellas (FORTH), Heraklion, Greece
  5. 5Science and Technology Park of Crete, GNOSIS Data Analysis PC, Heraklion, Greece
  6. 6Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia
  7. 7Department of Thoracic Surgery RT, Rigshospitalet, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
  8. 8Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
  9. 9Department of Radiology, Akershus University Hospital, Lørenskog, Norway
  1. Correspondence to Dr Oluf Dimitri Røe; olufdroe{at}yahoo.no

Abstract

Hypothesis We hypothesise that the validated HUNT Lung Cancer Risk Model would perform better than the NLST (USA) and the NELSON (Dutch‐Belgian) criteria in the Danish Lung Cancer Screening Trial (DLCST).

Methods The DLCST measured only five out of the seven variables included in validated HUNT Lung Cancer Model. Therefore a ‘Reduced’ model was retrained in the Norwegian HUNT2-cohort using the same statistical methodology as in the original HUNT model but based only on age, pack years, smoking intensity, quit time and body mass index (BMI), adjusted for sex. The model was applied on the DLCST-cohort and contrasted against the NLST and NELSON criteria.

Results Among the 4051 smokers in the DLCST with 10 years follow-up, median age was 57.6, BMI 24.75, pack years 33.8, cigarettes per day 20 and most were current smokers. For the same number of individuals selected for screening, the performance of the ‘Reduced’ HUNT was increased in all metrics compared with both the NLST and the NELSON criteria. In addition, to achieve the same sensitivity, one would need to screen fewer people by the ‘Reduced’ HUNT model versus using either the NLST or the NELSON criteria (709 vs 918, p=1.02e-11 and 1317 vs 1668, p=2.2e-16, respectively).

Conclusions The ‘Reduced’ HUNT model is superior in predicting lung cancer to both the NLST and NELSON criteria in a cost-effective way. This study supports the use of the HUNT Lung Cancer Model for selection based on risk ranking rather than age, pack year and quit time cut-off values. When we know how to rank personal risk, it will be up to the medical community and lawmakers to decide which risk threshold will be set for screening.

  • lung cancer screening
  • risk prediction model
  • HUNT
  • NLST
  • NELSON

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000512

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    Footnotes

    • Contributors ODR and HGA envisaged the study. Study design by ODR and MM. Analysis by MM, VL, IT. Figures by ODR. Data obtained by ODR, HGA, ZS, JHP. Paper written by ODR, IT, MM, OTDN. All authors reviewed the paper and agreed on the final version of the paper.

    • Funding The study was funded in part by the BONNIE J. ADDARIO LUNG CANCER FOUNDATION AND INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER (IASLC) JOINT AWARD 2016, the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the NTNU, Norway, and the Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway.

    • Competing interests None declared.

    • Patient and public involvement statement Patients or the public were not involved in the design, or conduct, or reporting, or dissemination of our research

    • Patient consent for publication Not required.

    • Ethics approval The use of the data was approved by the the HUNT board and the regional ethical committee of health and research ethics of Mid-Norway (approval ID 2012/5548) and the DLCST data by the study board.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data availability statement Data are available upon reasonable request. The raw data of the HUNT Databank can be available after application. Raw data of the DLCST has to be applied for to the DLCST steering committee.