Personalised lung cancer risk stratification and lung cancer screening: do general practice electronic medical records have a role?

Jani, B. D. , Sullivan, M. K. , Hanlon, P. , Nicholl, B. I. , Lees, J. S. , Brown, L., MacDonald, S. , Mark, P. B. , Mair, F. S. and Sullivan, F. M. (2023) Personalised lung cancer risk stratification and lung cancer screening: do general practice electronic medical records have a role? British Journal of Cancer, (doi: 10.1038/s41416-023-02467-9) (PMID:37880510) (Early Online Publication)

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Background: In the United Kingdom (UK), cancer screening invitations are based on general practice (GP) registrations. We hypothesize that GP electronic medical records (EMR) can be utilised to calculate a lung cancer risk score with good accuracy/clinical utility. Methods: The development cohort was Secure Anonymised Information Linkage-SAIL (2.3 million GP EMR) and the validation cohort was UK Biobank-UKB (N = 211,597 with GP-EMR availability). Fast backward method was applied for variable selection and area under the curve (AUC) evaluated discrimination. Results: Age 55–75 were included (SAIL: N = 574,196; UKB: N = 137,918). Six-year lung cancer incidence was 1.1% (6430) in SAIL and 0.48% (656) in UKB. The final model included 17/56 variables in SAIL for the EMR-derived score: age, sex, socioeconomic status, smoking status, family history, body mass index (BMI), BMI:smoking interaction, alcohol misuse, chronic obstructive pulmonary disease, coronary heart disease, dementia, hypertension, painful condition, stroke, peripheral vascular disease and history of previous cancer and previous pneumonia. The GP-EMR-derived score had AUC of 80.4% in SAIL and 74.4% in UKB and outperformed ever-smoked criteria (currently the first step in UK lung cancer screening pilots). Discussion: A GP-EMR-derived score may have a role in UK lung cancer screening by accurately targeting high-risk individuals without requiring patient contact.

Item Type:Articles
Additional Information:Dr Bhautesh Dinesh Jani’s time was partly funded by a research grant from the British Medical Association. Chief Scientist Office (CSO, Scotland) funded SAIL data access costs (PCL/18/03). JSL was funded by a via a CSO Postdoctoral Lectureship Award (PCL/20/10). The Medical Research Council fund MKS (MR/V001671/1) and PH (MR/S021949/1).
Status:Early Online Publication
Glasgow Author(s) Enlighten ID:Jani, Dr Bhautesh and Mark, Professor Patrick and Sullivan, Dr Michael and Lees, Jennifer and Hanlon, Dr Peter and Mair, Professor Frances and Nicholl, Dr Barbara and Macdonald, Professor Sara
Authors: Jani, B. D., Sullivan, M. K., Hanlon, P., Nicholl, B. I., Lees, J. S., Brown, L., MacDonald, S., Mark, P. B., Mair, F. S., and Sullivan, F. M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
Journal Name:British Journal of Cancer
Publisher:Springer Nature
ISSN (Online):1532-1827
Published Online:25 October 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in British Journal of Cancer 2023
Publisher Policy:Reproduced under a Creative Commons License

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