Risk Model-Based Lung Cancer Screening and Racial and Ethnic Disparities in the US.
Risk Model-Based Lung Cancer Screening and Racial and Ethnic Disparities in the US.
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DOI：
10.1001/jamaoncol.2023.4447
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发表时间：
2023-12-01
期刊：
影响因子：
28.4
通讯作者：
Han, Summer S.
中科院分区：
文献类型：
--
作者：
Choi, Eunji;Ding, Victoria Y.;Luo, Sophia J.;ten Haaf, Kevin;Wu, Julie T.;Aredo, Jacqueline V.;Wilkens, Lynne R.;Freedman, Neal D.;Backhus, Leah M.;Leung, Ann N.;Meza, Rafael;Lui, Natalie S.;Haiman, Christopher A.;Park, Sung-Shim Lani;Le Marchand, Loic;Neal, Joel W.;Cheng, Iona;Wakelee, Heather A.;Tammemaegi, Martin C.;Han, Summer S.
基于风险的肺癌筛查是否可以减少种族和民族差异，并提高筛查效率，而不是美国5个种族和民族的国家肺癌筛查指南？在这项包括105261名有吸烟史的成年人的队列研究中，2021年美国预防服务工作组指南显示，非洲裔美国人的死亡率-发病率比白色人低53%。在基于风险的筛查中，非洲裔美国人和白色人之间的差异减少了，在其他少数群体中观察到的差异最小，并提高了跨种族和种族的筛查效率。这项研究的结果表明，基于风险的筛查减少了种族和民族的差异，同时保持提高筛查效率。经修订的2021年美国预防服务工作组（USPSTF）肺癌筛查指南已被证明与2013年指南相比，可减少非裔美国人和白色人之间筛查资格和表现的差异。然而，美国其他种族和族裔群体之间的潜在差异仍然未知。基于风险模型的筛查可以减少种族和民族差异，提高筛查性能，但关键风险预测模型的验证及其筛查性能均未通过种族和民族进行检查。验证和重新校准前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验2012（PLCOm 2012）模型-一种基于主要为白色人群的成熟风险预测模型-在美国跨人种和种族，并使用PLCOm 2012与USPSTF 2021标准通过基于风险的筛查评价人种和种族差异以及筛查性能。在基于人群的队列设计中，多种族队列研究在1993-1996年招募了参与者，随访至2018年12月31日。数据分析于2022年4月1日至5月19日进行。2023.共纳入105261名有吸烟史的成年人。6年肺癌风险是通过重新校准的PLCOm 2012（即PLCOm 2012-更新）计算的，筛选合格性基于6年风险阈值大于或等于1.3%，产生与USPSTF 2021指南相似的合格性。预测准确性、筛选致死率-发病率（E-I）比（即合格病例数与发病病例数的比值）和筛选性能（敏感性、特异性和筛选检测1例肺癌所需的数量）。在105 261名参与者中男性60 011人，占57.0%;平均[SD]年龄，59.8 [8.7]岁），包括19 258例（18.3%）非裔美国人，27 227人（25.9%）日裔美国人，21 383人（20.3%）拉丁裔，8368人夏威夷原住民/其他太平洋岛民（7.9%）和白色个体（29025人，27.6%）中，1464人（1.4%）在入组后6年内发生肺癌。PLCOm 2012-更新显示了跨人种和种族的良好预测准确性（曲线下面积，0.72-0.82）。USPSTF 2021标准在非裔美国人个体中产生了很大的差异，其E-I比率比白色个体低53%（E-I比率：9.5 vs 20.3; P < .001）。在基于风险的筛查（PLCOm 2012-更新6年风险≥1.3%）下，非裔美国人和白色个体之间的差异显著降低（E-I比：15.9 vs 18.4; P <0.001），在其他少数群体（包括日裔美国人、拉丁美洲人和夏威夷原住民/其他太平洋岛民）中观察到的差异极小。基于风险的筛查产生了优于USPSTF 2021标准的上级总体和种族和种族特异性性能，具有更高的总体敏感性（67.2% vs 57.7%）和更低的筛选数量（26 vs 30），特异性相似（76.6%）。这项队列研究的结果表明，与USPSTF 2021标准相比，基于风险的肺癌筛查可以减少种族和民族差异，并提高跨种族和民族的筛查性能。这项队列研究评估了使用基于风险的肺癌筛查与前列腺癌，肺癌，结直肠癌和卵巢癌筛查试验2012预测模型，以解决吸烟史个体的种族和民族差异。
Can risk-based lung cancer screening reduce racial and ethnic disparities and improve screening efficiency vs the national lung cancer screening guidelines across 5 races and ethnicities in the US? In this cohort study including 105 261 adults with a smoking history, the 2021 US Preventive Services Task Force guidelines yielded a large disparity in African American individuals whose eligibility-incidence ratio was 53% lower than that of White individuals. Under risk-based screening, the disparity between African American and White individuals was reduced—with minimal disparities observed across other minoritized groups—and improved screening efficiency across races and ethnicities. The findings of this study suggest that risk-based screening reduces racial and ethnic disparities while maintaining improved screening efficiency. The revised 2021 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening have been shown to reduce disparities in screening eligibility and performance between African American and White individuals vs the 2013 guidelines. However, potential disparities across other racial and ethnic groups in the US remain unknown. Risk model–based screening may reduce racial and ethnic disparities and improve screening performance, but neither validation of key risk prediction models nor their screening performance has been examined by race and ethnicity. To validate and recalibrate the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) model—a well-established risk prediction model based on a predominantly White population—across races and ethnicities in the US and evaluate racial and ethnic disparities and screening performance through risk-based screening using PLCOm2012 vs the USPSTF 2021 criteria. In a population-based cohort design, the Multiethnic Cohort Study enrolled participants in 1993-1996, followed up through December 31, 2018. Data analysis was conducted from April 1, 2022, to May 19. 2023. A total of 105 261 adults with a smoking history were included. The 6-year lung cancer risk was calculated through recalibrated PLCOm2012 (ie, PLCOm2012-Update) and screening eligibility based on a 6-year risk threshold greater than or equal to 1.3%, yielding similar eligibility as the USPSTF 2021 guidelines. Predictive accuracy, screening eligibility-incidence (E-I) ratio (ie, ratio of the number of eligible to incident cases), and screening performance (sensitivity, specificity, and number needed to screen to detect 1 lung cancer). Of 105 261 participants (60 011 [57.0%] men; mean [SD] age, 59.8 [8.7] years), consisting of 19 258 (18.3%) African American, 27 227 (25.9%) Japanese American, 21 383 (20.3%) Latino, 8368 (7.9%) Native Hawaiian/Other Pacific Islander, and 29 025 (27.6%) White individuals, 1464 (1.4%) developed lung cancer within 6 years from enrollment. The PLCOm2012-Update showed good predictive accuracy across races and ethnicities (area under the curve, 0.72-0.82). The USPSTF 2021 criteria yielded a large disparity among African American individuals, whose E-I ratio was 53% lower vs White individuals (E-I ratio: 9.5 vs 20.3; P < .001). Under the risk-based screening (PLCOm2012-Update 6-year risk ≥1.3%), the disparity between African American and White individuals was substantially reduced (E-I ratio: 15.9 vs 18.4; P < .001), with minimal disparities observed in persons of other minoritized groups, including Japanese American, Latino, and Native Hawaiian/Other Pacific Islander. Risk-based screening yielded superior overall and race and ethnicity–specific performance to the USPSTF 2021 criteria, with higher overall sensitivity (67.2% vs 57.7%) and lower number needed to screen (26 vs 30) at similar specificity (76.6%). The findings of this cohort study suggest that risk-based lung cancer screening can reduce racial and ethnic disparities and improve screening performance across races and ethnicities vs the USPSTF 2021 criteria. This cohort study evaluates use of risk-based screening for lung cancer with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 prediction model to address racial and ethnic disparities in individuals with a smoking history.
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影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
影响因子：
4.1
作者：
da Silva Teles, Gustavo Borges;Sandoval Macedo, Ana Carolina;Szarf, Gilberto
通讯作者：
Szarf, Gilberto
影响因子：
10.3
作者：
Cronin, Kathleen A.;Gail, Mitchell H.;Albanes, Demetrius
通讯作者：
Albanes, Demetrius
DOI：
10.1001/jama.2016.6255
发表时间：
2016-06-07
期刊：
JAMA
影响因子：
--
作者：
Katki HA;Kovalchik SA;Berg CD;Cheung LC;Chaturvedi AK
通讯作者：
Chaturvedi AK
影响因子：
13.8
作者：
Reese TJ;Schlechter CR;Potter LN;Kawamoto K;Del Fiol G;Lam CY;Wetter DW
通讯作者：
Wetter DW