{"entity":{"id":"idea-prev-lung-screening-risk-model-eligibility","kind":"idea","name":"Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers","aka":[],"tldr":"Pack-year rules miss people who get lung cancer without heavy smoking, including East Asian women who never smoked, as Taiwan's TALENT study showed. Eligibility by a validated risk model with a set threshold, plus a never-smoker arm where family history matters, would find more cancers per scan.","summary":"PLCOm2012 risk-based selection is more efficient than USPSTF criteria; Taiwan's TALENT study found high detection in never-smoking women with family history. Propose eligibility by a validated risk model with a threshold (e.g. 1.5% six-year risk) plus a never-smoker arm for populations with high never-smoker incidence.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022)","url":"https://doi.org/10.1126/science.aay9040"}],"tags":[],"related":["lung-cancer-evidence-roadmap","idea-lung-screening-eligibility-by-risk-not-pack-years"],"cancers":["nsclc"],"sections":["early-detection"],"technologies":["ct"],"targets":["egfr"],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-trial-diversity"],"keyPapers":["paper-crosby-science"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Risk-model eligibility increases cancers detected per 1,000 scans by at least 30%, and never-smoker criteria in East Asian populations achieve detection rates comparable to smoker screening.","rationale":"Screening efficiency scales with baseline risk; never-smoker EGFR-mutant lung cancer in East Asian women is a distinct epidemic not captured by tobacco criteria.","test":"Pragmatic comparison within a national programme (England's Targeted Lung Health Check) and a never-smoker RCT in Taiwan, China, or Korea with mortality follow-up.","maturity":"being-tested-at-scale","actor":"policy","cost":"medium","horizonYears":5},"route":"/ideas/idea-prev-lung-screening-risk-model-eligibility/","neighbours":{"roadmap":[{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"idea":[{"id":"idea-lung-screening-eligibility-by-risk-not-pack-years","kind":"idea","name":"Decide who is screened for lung cancer by individual risk, not by pack-years","route":"/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/"}],"cancer":[{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"ct","kind":"technology","name":"CT (computed tomography)","route":"/technologies/ct/"}],"target":[{"id":"egfr","kind":"target","name":"EGFR","route":"/targets/egfr/"}],"bottleneck":[{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"paper":[{"id":"paper-crosby-science","kind":"paper","name":"Early detection of cancer","route":"/key-papers/paper-crosby-science/"},{"id":"paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","kind":"paper","name":"Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers","route":"/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/"},{"id":"paper-nelson-nejm-2020","kind":"paper","name":"NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms","route":"/key-papers/paper-nelson-nejm-2020/"},{"id":"paper-nlst-nejm-2011","kind":"paper","name":"NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers","route":"/key-papers/paper-nlst-nejm-2011/"},{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/"}]}}