State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States.
State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States.
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DOI：
10.1093/jnci/djaa170
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发表时间：
2021-08-02
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影响因子：
--
通讯作者：
Silvestri GA
中科院分区：
文献类型：
--
作者：
Fedewa SA;Kazerooni EA;Studts JL;Smith RA;Bandi P;Sauer AG;Cotter M;Sineshaw HM;Jemal A;Silvestri GA
自2013年以来，建议对当前和曾经吸烟的老年人（即符合条件的成年人）每年进行低剂量胸部计算机断层扫描肺癌筛查（LCS）。在美国各地，人们对这种做法的接受速度缓慢且变化不定。我们估计了2016年至2018年期间全国和州一级的LCS率和增长率。美国放射学会的肺癌筛查登记被用来记录筛查事件。基于人口的调查、美国人口普查和癌症登记数据被用来估计符合条件的成年人数量和肺癌死亡率（即负担）。使用符合条件的成年人的肺癌筛查率（SRs）和具有95%置信区间（CI）的筛查率比率来衡量各州和年份的变化。在全国范围内，SR在2016年（3.3%,95% CI = 3.3%至3.7%）和2017年（3.4%,95% CI = 3.4%至3.9%）之间保持稳定，在2018年增加到5.0% (95% CI = 5.0%至5.7%)（2018年与2016年的SR比率= 1.52,95% CI = 1.51至1.62）。2018年，肺癌负担高的几个南部州（如密西西比州、西弗吉尼亚州和阿肯色州）在符合条件的成年人中具有相对较低的SRs(<4%)，而肺癌负担较低的几个东北部州（如马萨诸塞州、佛蒙特州和新罕布什尔州）的SRs最高（12.8%-15.2%）。肯塔基州是个例外，该州的肺癌死亡率和SRs最高（13.7%）。在全国范围内，每20名符合条件的成年人中只有不到1人接受了LCS，各州的接受情况差异很大。除肯塔基州支持全面实施LCS外，LCS率与各州的肺癌负担不一致。
Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. The American College of Radiology’s Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year. Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation’s highest lung cancer mortality rate and one of the highest SRs (13.7%). Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.
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