Breakthrough in personalised lung cancer screening

Higher effectiveness for those who smoked less

Associate Professor Andreas Alfons and Max Welz, former PhD candidate at Erasmus School of Economics worked together with Assistant Professor Kevin ten Haaf and a team of researchers from Erasmus MC on a study on lung cancer screening effectiveness published in Nature Communications, “A comparative analysis of heterogeneity in lung cancer screening effectiveness in two randomised controlled trials”.

They found that screening prevents more deaths among people who smoked less or quit longer ago. These individuals are more likely to develop cancers that grow slower than others and can be detected early, when treatment is still possible. In contrast, people who have smoked heavily for many years or who are still smoking have a higher chance of developing aggressive cancers that progress more rapidly and are less likely to be caught by screening. Therefore, by quitting smoking individuals can not only lower their risk of developing lung cancer, but also lower their risk of developing one of the more aggressive types of lung cancers.

The role of cancer type and smoking history

The study analysed data from over 68,000 participants in two major clinical trials. The findings reveal that screening effectiveness differs by cancer type. For slower-growing cancers such as adenocarcinoma, screening reduced lung cancer deaths by up to 23%. People who have smoked longer and heavier or who still do have a higher prevalence of more aggressive, quick-progressing cancers, like small-cell carcinoma. For these types, the reduction of death rates was only around 10%. 

A convergence of expertise

This impactful study was a collaboration between Erasmus MC and the Econometric Institute at Erasmus School of Economics. It was in part supported through an Open Mind grant from the Convergence, a joint programme of Erasmus MC, Erasmus University Rotterdam, and TU Delft. The research was initiated by Max Welz, who conducted the study during his PhD at Erasmus School of Economics, under guidance of Associate Professor Andreas Alfons. Using advanced econometric methods, the team was able to analyse complex individual-level data from both trials. ‘These modern techniques are better at correcting for differences between groups than those that have been applied previously,’ says Kevin ten Haaf, senior author of the study. ‘They were originally developed for evaluating medical treatments, and we asked ourselves: what if we apply them to screening? It gave us interesting new insights.’