Global development and validation of the Lung Cancer Prevention Score (LCPS): A quantitative framework linking policy strength, incidence, and outcomes across 40 countries.

Abstract

10518 Background: Lung cancer is the leading cause of cancer worldwide. Despite advances in tobacco control, national prevention efforts remain fragmented. We developed and validated the Lung Cancer Prevention Score (LCPS), a 0–100 composite linking prevention policy strength with real-world outcomes for global benchmarking and equity tracking. Methods: Two LCPS models were created. Policy LCPS quantified 12 weighted domains: smoke-free laws, TAPS bans, ≥50% pictorial warnings, ≥75% excise tax, plain packaging, legal-age limits, e-cigarette control, LDCT screening, asbestos ban, radon plan, clean-cooking access, and occupational carcinogen controls. Data-Driven LCPS combined age-standardized incidence (ASIR), mortality (ASMR), mortality-to-incidence ratio (MIR), smoking prevalence, GDP, health expenditure, and HDI (normalized 0–1; higher = stronger prevention). Data from GLOBOCAN 2022, WHO GTCR 2023, World Bank, and UNDP HDR 2023 covered 40 countries (G20 + 20 others). Analyses included correlation, regression (adjusted for GDP, HDI), Bland–Altman agreement, and ROC AUC for MIR ≤0.60. Results: Among 32 complete datasets, Policy and Data-Driven LCPS correlated moderately (r = 0.31; 95% CI –0.04–0.60). Discrimination of favorable outcomes (MIR ≤0.60) showed AUC 0.68 vs 0.77. High-policy countries (≥75) had lower smoking (17%) and MIR (0.45) than those <60 (27%, 0.65; p <0.001). Policy LCPS inversely correlated with ASIR (r = –0.42; p = 0.004); Data-Driven LCPS showed a stronger link (r = –0.55; p <0.001). Each 10-point LCPS-D increase predicted 2.4 fewer cases per 100 000 (β = –0.24 ± 0.07; p = 0.002). Results were consistent across income tiers. Conclusions: LCPS provides a validated, reproducible framework connecting prevention policy to measurable cancer burden. Data-Driven LCPS reflected performance most accurately, while Policy LCPS defined actionable tiers linked to lower smoking, incidence, and MIR. LCPS serves as a quantitative global benchmark for policy evaluation. Policy-driven lung cancer prevention score (LCPS-P) and data-driven lung cancer prevention score (LCPS-D): Domains and scoring weights. Component Type Wt Rule / Effect Smoke-free law P 1 Yes = 1 TAPS ban P 1 Yes = 1; Partial = 0.5 Pictorial ≥ 50 % P 1 Yes = 1 Excise ≥ 75 % P 1 Yes = 1 Plain pack P 0.5 Yes = 1 Legal age P 0.5 18–19 = 0.5; ≥ 21 = 1 E-cig reg P 0.5 Full/Prescr = 1; None = 0 LDCT screen P 2 Nat = 1; Reg = 0.5 Asbestos ban P 1 Yes = 1 Radon plan P 1 Yes = 1 Clean-cook > 90 % P 1 Yes = 1 Occ carcinogen ctrl P 1.5 Yes = 1 ASIR D 1 Lower = better (1–scaled ASIR) ASMR D 1 Lower = better (1–scaled ASMR) MIR D 1 Lower = better (1–scaled MIR) Smoking prev D 1 Lower = better GDP D 0.5 Higher = better Health exp D 0.75 Higher = better HDI D 0.5 Higher = better Scoring — — Policy LCPS = Σ (weight×value)/12×100; Data LCPS = Σ (weighted norm)/Σ weights×100