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In the randomized National Lung Screening Trial (NLST), three annual screenings with low-dose computed tomography (CT) lowered lung cancer–related mortality among current or former (within 15 years) smokers (age range, 55–74) with smoking histories of ≥30 pack-years (NEJM JW Gen Med Jul 14 2011). But the relatively small absolute benefit (3 fewer deaths per 1000 screened during average follow-up of 6.5 years) and the high rate of false-positive CT findings raise this question: Can we target screening to a subgroup of smokers most likely to benefit?
To address this question, researchers used data from the NLST control group to develop a risk-prediction model for lung cancer–related death; the model incorporated age, sex, race, family history,…