Lung Cancer Risk and Demographic Characteristics of Current 20–29 Pack-year Smokers: Implications for Screening

• Published in: JNCI : Journal of the National Cancer Institute Vol. 107; no. 11; p. djv226
• Main Authors: Pinsky, Paul F., Kramer, Barnett S.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.11.2015
• Subjects: Aged; Confounding Factors (Epidemiology); Female; Follow-Up Studies; Humans; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - ethnology; Lung Neoplasms - etiology; Lung Neoplasms - prevention & control; Male; Mass Chest X-Ray - methods; Middle Aged; Odds Ratio; Proportional Hazards Models; Radiation Dosage; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Smoking - adverse effects; Surveys and Questionnaires; Tomography, X-Ray Computed - methods; United States - epidemiology
• ISSN: 0027-8874; 1460-2105; 1460-2105
• DOI: 10.1093/jnci/djv226

Based on current recommendations, 30+ pack-years of smoking are required for eligibility for low-dose CT (LDCT) lung cancer screening; former smokers must have quit within 15 years. We investigated whether current smokers with 20 to 29 pack-years have similar lung cancer risks as eligible former smokers and also whether they have a different demographic profile. The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) was a randomly assigned screening trial of subjects age 55 to 74 years with chest radiographs (CXR) used for lung cancer. Subjects completed a baseline questionnaire containing smoking history questions. Cox proportional hazards models, adjusted for age and sex, were utilized to estimate hazard ratios (HRs) for various smoking history groups. Next, we utilized the National Health Interview Survey (NHIS), which inquired about smoking history and race/ethnicity, to analyze the demographic profiles of various high-risk smoking history categories. All statistical tests were two-sided. The PLCO cohort included 18 114 former and 12 243 current LDCT-eligible smokers, plus 2283 20- to 29-pack-year current smokers. The hazard ratio for 20- to 29-pack-year current smokers compared with eligible (30+ pack-year) former smokers was 1.07 (95% confidence interval [CI] = 0.75 to 1.5). Based on the NHIS, 10 million persons in the United States are currently LDCT eligible; an additional 1.6 million (16%, 95% CI = 13.6% to 19.0%) are 20- to 29-pack-year current smokers. The percentage increase in eligibles if 20- to 29-pack-year current smokers were included was substantially greater for women than men (22.2%, 95% CI = 17.9% to 26.7%; vs 12.2%, 95% CI = 9.3% to 15.3%, P < .001) and for minorities than non-Hispanic whites (30.0%, 95% CI = 24.2% to 36.0%; vs 14.1%, 95% CI = 11.1% to 17.0%, P < .001). The potential benefits and harms of recommending LDCT screening for 20 to 29-pack-year current smokers should be assessed.