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This study develops and evaluates a range of ensemble learning models for lung cancer prediction using lifestyle and clinical indicators, with an emphasis on both predictive performance and interpretability. Five base learners\u2014logistic regression, k-nearest neighbors, na\u00efve Bayes, support vector machine, and linear discriminant analysis\u2014were used to construct multiple boosting and bagging models. Building on these, voting and stacking ensembles were designed by selectively combining high-performing models. All approaches were evaluated on the original dataset as well as on balanced and upsampled variants derived through synthetic augmentation. Model performance was assessed using accuracy, precision, recall, F1-score, Matthews correlation coefficient (MCC), and AUC-ROC. The results show that ensemble approaches consistently outperform individual models, with voting and stacking demonstrating superior performance over boosting and bagging methods. The stacking model achieved the strongest overall performance across all evaluated models. On the original dataset, which provides a more realistic representation of practical deployment conditions, it attained an accuracy of 93.53%. Performance further improved on the balanced and upsampled datasets on the upsampled dataset. To enhance transparency, SHAP and LIME were employed to provide global and local interpretability, respectively, enabling identification of key clinical factors and patient-specific risk drivers. The analysis highlights both alignment with known clinical patterns and dataset-driven variations, supporting informed interpretation of model outputs. The results suggest that stacking-based ensembles can improve risk prediction from lifestyle and clinical indicators while maintaining model transparency through SHAP and LIME explanations. These findings highlight the potential of interpretable ensemble learning as a decision-support tool for lung cancer risk assessment.<\/jats:p>","DOI":"10.1371\/journal.pone.0357291","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:33:32Z","timestamp":1788456812000},"page":"e0357291","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lung cancer risk prediction using interpretable ensemble models on lifestyle and clinical data"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9925-0402","authenticated-orcid":true,"given":"Shahid Mohammad","family":"Ganie","sequence":"first","affiliation":[{"name":"College of Applied Medical Sciences, King Faisal University","place":["Al-Ahsa, Saudi Arabia"],"department":["Department of Health Information Management and Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9438-9309","authenticated-orcid":true,"given":"Pijush Kanti","family":"Dutta Pramanik","sequence":"additional","affiliation":[{"name":"School of Computer Applications and Technology, Galgotias University","place":["Greater Noida, Uttar Pradesh, India"]},{"name":"Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston","place":["Houston, Texas, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston","place":["Houston, Texas, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"pone.0357291.ref001","author":"World Health Organization","year":"2022"},{"key":"pone.0357291.ref002","article-title":"VER-Net: a hybrid transfer learning model for lung cancer detection using CT scan images","volume":"24","author":"A Saha","year":"2024","journal-title":"BMC Medical Imaging"},{"key":"pone.0357291.ref003","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.semcancer.2018.02.002","article-title":"Cancer molecular markers: a guide to cancer detection and management","volume":"52","author":"M Nair","year":"2018","journal-title":"Sem Cancer Biol"},{"key":"pone.0357291.ref004","doi-asserted-by":"crossref","first-page":"119961","DOI":"10.1016\/j.eswa.2023.119961","article-title":"Lung cancer detection from CT scans using modified DenseNet with feature selection methods and ML classifiers","volume":"224","author":"MG Lanjewar","year":"2023","journal-title":"Expert Syst Appl"},{"key":"pone.0357291.ref005","doi-asserted-by":"crossref","unstructured":"Ganie SM, Pramanik PKD. 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