Assessing the impact of increasing lung screening eligibility by relaxing the maximum years-since-quit threshold: A simulation modeling study.
Assessing the impact of increasing lung screening eligibility by relaxing the maximum years-since-quit threshold: A simulation modeling study.
复制标题
通过放宽戒烟后最长年数阈值来评估增加肺部筛查资格的影响：模拟模型研究。
DOI：
10.1002/cncr.34925
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发表时间：
2024
期刊：
影响因子：
6.2
通讯作者：
deKoning,Harry
中科院分区：
文献类型：
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作者：
Meza,Rafael;Cao,Pianpian;deNijs,Koen;Jeon,Jihyoun;Smith,RobertA;TenHaaf,Kevin;deKoning,Harry
2021年，美国预防服务工作组扩大了其肺部筛查建议，包括年龄在50-80岁之间的曾吸烟者，至少有20包年的暴露量，戒烟后不到15年。然而，研究表明，筛选人谁以前吸烟与较长的YSQ可能是benefit.MethodsThe作者使用了两个验证的肺癌模型，以评估的好处和危害筛选使用各种YSQ阈值（10，15，20，25，30，没有YSQ）和年龄在筛选停止。还评估了只在进入时执行YSQ标准而不在退出时执行YSQ标准的影响。结果包括筛查次数、筛查百分比、筛查益处（避免肺癌死亡、获得生命年）和危害（假阳性检测、过度诊断病例、辐射诱发的肺癌死亡）。进行敏感性分析，以评估限制筛选那些谁有至少5年的预期寿命。ResultsAs的YSQ标准放宽，屏幕的数量和筛选的好处和危害增加。提高停止筛查的年龄会带来额外的好处，但正如预期的那样，过度诊断更多，因为80岁以上人群的筛查增加了。将筛查限制在那些至少有5年的预期寿命将保持大部分的好处，同时大大减少harms.ConclusionsExpanding筛选的人谁以前吸烟，并有大于15 YSQ将导致在相当大的增加避免死亡和寿命年获得。虽然会发生额外的伤害，但可以通过确保筛查仅限于那些具有合理预期寿命的人来减轻这些伤害。
BackgroundIn 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50–80 years who had ever smoked and had at least 20 pack‐years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.MethodsThe authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life‐years gained), and harms (false‐positive tests, overdiagnosed cases, radiation‐induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy.ResultsAs the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms.ConclusionsExpanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life‐years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.