Expected results
lung cancer, malignancy
LUNG CANCER
Of 7,135 participants in the NELSON CT-screening arm, 390 (5.5%) developed lung cancer over 10-years follow up. Combined with the DLCST data, the total number of screened participants is 11,239, of whom 490 (4.4%) were diagnosed with lung cancer during the screening rounds or during follow-up.The following outcomes are expected to be obtained: polygenic risk scores and air pollution as measures of genetic and environmental risk, the AI malignancy score for all lung nodules, and other CT imaging biomarkers. All new measures will be related to lung cancer risk and survival, and predictive measures will be included in new participant selection and nodule discrimination models. The newly developed models will be applied on the combined data from the NELSON study and DLCST where possible. The new multi-source models for participant selection and lung nodule discrimination will be externally validated on the NLST data. The cost-effectiveness of these prediction models will also be assessed.The first model this study aims to develop, is for stricter selection of screening participants based on risk of lung cancer and sufficient life expectancy. In the NELSON CT-screening arm, the vast majority (82%) of deceased participants died from other causes than lung cancer [This project will for the first time integrate CT features for post-baseline-screening participant selection to recalibrate the predictive model and determine whether continuing screening is of benefit. Based on estimates from previous studies [To reduce the burden for those eventually selected for screening, a better method is needed to select CT-detected nodules with sufficiently high malignancy risk that would warrant short-term repeat CT or referral to a pulmonologist. In the NELSON study, 1.6% and 19.2% participants had positive or indeterminate results at baseline, respectively. Eventually, 95.5% of them tested negative for lung cancer. A study [