Recent Highlights

The CISNET Lung Working Group published a modeling analysis of Tobacco 21 policies across the US in JAMA Health Forum on December 20th, 2024 which marks the 5th anniversary of the signing of the federal Tobacco21 law. Listen to lead author Dr. Jamie Tam discuss the study and its implications on the JAMA Health Forum podcast.

CISNET models estimate that US Tobacco 21 policies could avert up to 526,000 premature smoking-attributable deaths and lead to more than 13 million life-years gained by 2100. The analysis uses detailed state-specific data on smoking patterns, mortality, and Tobacco 21 policy coverage to comprehensively evaluate the projected health gains associated with Tobacco 21 policies implemented at the local, state, and federal levels. Explore findings from this study interactively for each state through the Tobacco Control Policy Tool at tobaccopolicyeffects.org.

The CISNET Lung Working group was commissioned by the U.S. Preventive Services Task Force (USPSTF) in 2011-2013 and 2019-2021 to conduct decision analyses to inform their lung cancer screening recommendations. In the first analysis done for the 2013 recommendations, five lung natural history models concluded that implementing annual low-dose CT (LDCT) screening for lung cancer would result in lung cancer mortality reductions in the US, and that screening individuals aged 55 through 80 years with 30 or more pack-years’ exposure to smoking and no more than 15 years of quitting had a favorable benefit–harm ratio for (de Koning et al, 2014). This work supported the Task Force's 2013 lung cancer screening recommendation (Moyer USPSTF, 2014).

In the 2019-2021 decision analysis to inform the 2021 USPSTF lung screening recommendations, four lung natural history models were used to extrapolate the benefits and harms of lung LDCT screening strategies with either pack-year and year-since-quit eligibility criteria as the 2013 recommendations (risk factor–based) or with eligibility based on individual risk calculated using a multivariate risk prediction model (risk model–based). The findings suggest that optimally targeted LDCT screening could lead to important reductions in lung cancer mortality and result in significant life-years gained (Meza et al, 2021; Meza et al, AHRQ). The study found that screening individuals aged 50-80 who have a history of smoking a pack of cigarettes every day on average for at least 20 years would result in more benefits than the 2013 criteria and less disparities in screening eligibility by gender and race/ethnicity. The study also found that risk model–based vs risk factor–based strategies were estimated to be associated with more benefits and fewer radiation-related deaths but more overdiagnosed cases. This work supported the Task Force's 2021 lung cancer screening recommendations, which expanded screening to age 50-80 and to include those with 20 pack-years of smoking exposure or more (USPSTF, 2021)

Results of these studies were published in the following articles in the Annals of Internal Medicine in 2013 and in JAMA in 2021:

de Koning HJ, Meza R, Plevritis SK, ten Haaf K, Munshi VN, Jeon J, Erdogan SA, Kong CY, Han SS, van Rosmalen J, Choi SE, Pinsky PF, Berrington de Gonzalez A, Berg CD, Black WC, Tammemägi MC, Hazelton WD, Feuer EJ, McMahon PM. Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med 2014 Mar 4;160(5):311-20. [Abstract]

Meza R, Jeon J, Toumazis I, Ten Haaf K, Cao P, Bastani M, Han SS, Blom EF, Jonas DE, Feuer EJ, Plevritis SK, de Koning HJ, Kong CY. Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: Modeling Study for the US Preventive Services Task Force. JAMA. 2021 Mar 9;325(10):988-997. [Abstract]

Meza R, Jeon J, Toumazis I, ten Haaf K, Cao P, Bastani M, Han SS, Blom EF, Jonas D, Feuer EJ, Plevritis SK, de Koning HJ, Kong CY. Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: A Collaborative Modeling Study for the U.S. Preventive Services Task Force. AHRQ technical report. AHRQ Publication No. 20-05266-EF-2. Rockville, MD: Agency for Healthcare Research and Quality; 2021. https://www.ncbi.nlm.nih.gov/books/NBK568586/

US Preventive Services Task Force. Recommendation Statement. Screening for lung cancer. JAMA 2021; 325:962-970. [Abstract]

CISNET investigators collaborated with the US Preventive Services Task Force (USPSTF) to estimate the population benefits and harms of lung cancer screening in the US, evaluating the relative effectiveness of 576 alternative screening scenarios. The analyses supported the development of new lung cancer screening recommendations by the USPSTF (Moyer 2014; de Koning, Meza et al. 2014). Working with the USPSTF, CISNET investigators identified top-ranked scenarios that were determined to have an acceptable ratio of benefits and harms. According to the CISNET models, screening annually from ages 55-80 offers substantial benefits for individuals with at least 30 pack-years of exposure and no more than 15 years since quitting. These analyses provided additional evidence to support the recent USPSTF’s lung cancer screening guidelines, which gave low-dose CT screening a B recommendation (Moyer 2014).