The Timing of Screenings for Lung Cancer: A Decisional Model Based on U.S. Data

Health policy organizations do not recognize a reliable cost-benefit metric upon which to recommend the screening of individuals for lung cancer. However, many physicians find substantial merit in the procedure as an effective tool for managing the risk of lung cancer for individual patients. Between these two positions, one can observe a continuing search for a diagnostic methodology that permits early detection and justifies the initiation of therapies that will lower mortality rates while also reducing the social and economic costs of the leading form of cancer among adults in the United States. In this context, organizations such as the National Cancer Institute articulate present public policy, which sees no appreciable overall benefit for society from early screening, while physicians groups such as the Como International Position Conference and the International Early Cancer Action Program Investigators advocate early screening because of its potential efficacy for high-risk patients. The present paper exploits the recent availability of information about individual patient risk of lung cancer to propose a model for deciding upon the timing of a screening for this disease. The model embodies a subject’s risk characteristics and a ratio to weigh the benefit of a test that accurately discloses the presence of cancery against the costs of a false positive.