© The Author 2006. Published by Oxford University Press.
BRIEF COMMUNICATION |
Validation of a Model of Lung Cancer Risk Prediction Among Smokers
Affiliations of authors: Division of Cancer Control and Population Sciences (KAC), Division of Cancer Epidemiology and Genetics (MHG, DA), National Cancer Institute, Bethesda, MD; Information Management Services, Inc., Silver Spring, MD (ZZ); Memorial Sloan-Kettering Cancer Center, New York, NY (PBB); Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (JV)
Correspondence to: Kathleen A. Cronin, PhD, Statistical Research and Applications Branch, 6116 Executive Boulevard, Suite 504, Bethesda, MD 20892–8317 (e-mail: cronink{at}mail.nih.gov).
The Bach model was developed to predict the absolute 10-year risk of developing lung cancer among smokers by use of participants in the Carotene and Retinol Efficacy Trial of lung cancer prevention. We assessed the validity of the Bach model among 6239 smokers from the placebo arm of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. The expected numbers of lung cancer cases and deaths without lung cancer were calculated from the Bach model and compared with the observed numbers of corresponding events over 10 years. We found that the risk model slightly underestimated the observed lung cancer risk (number of lung cancers expected/number observed = 0.89, 95% confidence interval [CI] = 0.80 to 0.99) over 10 years. The competing risk portion of the model substantially underestimated risk of non-lung cancer mortality (number of non-lung cancer deaths expected/number observed = 0.61, 95% CI = 0.57 to 0.64) over 10 years. The age-specific concordance indices for 10-year predictions were 0.77 (95% CI = 0.70 to 0.84), 0.59 (95% CI = 0.53 to 0.65), 0.62 (95% CI = 0.57 to 0.67), and 0.57 (95% CI = 0.49 to 0.67) for the age groups 50–54, 55–59, 60–64, and 65–69 years, respectively. Periodic radiographic screening in the ATBC Study may explain why slightly more cancers were observed than expected from the Bach model.
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