Addressing Sex Disparities in Lung Cancer Screening Eligibility USPSTF vs PLCOm2012 Criteria
Addressing Sex Disparities in Lung Cancer Screening Eligibility USPSTF vs PLCOm2012 Criteria
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DOI：
10.1016/j.chest.2021.06.066
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发表时间：
2022-01-06
期刊：
影响因子：
9.6
通讯作者：
Feldman, Lawrence E.
中科院分区：
文献类型：
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作者：
Pasquinelli, Mary M.;Tammemagi, Martin C.;Feldman, Lawrence E.
背景：肺癌是美国女性癌症死亡的主要原因。前瞻性随机肺部筛查试验表明，与男性相比，筛查女性可提高肺癌死亡率。 研究问题：仅基于年龄和吸烟史的美国预防服务工作组 (USPSTF) 肺部筛查指南是否会导致资格中的性别差异？如果是，那么使用基于 11 个肺癌预测因子的 PLCOm2012 风险预测模型是否会减少性别差异？研究设计和方法：本回顾性研究对芝加哥种族筛查资格 (CREST) 中 883 例肺癌病例的分析确定了 USPSTF 与 PLCOm2012 资格标准的敏感性，并按性别分层。为了与 USPSTF 2013 和最近发布的 USPSTF 2021（2021 年 3 月 9 日发布）资格标准进行比较，使用 PLCOm2012 模型，风险阈值分别为 >= 1.7%/6 年（6 年）和 >= 1.0%/6 年。 结果：USPSTF 2013 筛选的敏感性为 46.7%女性和男性分别为 64.6% (P = .003) 和 USPSTF 2021 分别为 56.8% 和 71.8% (P = .02)。相比之下，PLCOm2012 >= 1.7%/6y 的灵敏度分别为 64.6% 和 70.4%，PLCOm2012 >= 1.0%/6y 的灵敏度分别为 77.4% 和 82.4%。 PLCOm2012 使用 >= 1.7%/6y 和 >= 1.0%/6y 阈值在女性和男性之间的敏感性差异不显着（均为 P = .07）。与男性相比，根据 USPSTF 2021 标准，女性更有可能不符合资格，因为她们的吸烟暴露量< 20包年（22.8% vs 14.8%；OR女性（vs）（男性），1.70；95% CI，1.19-2.44；P = .002），并且根据 USPSTF 2021 标准，这些不符合资格的女性中有 27% 符合资格。 PLCOm2012 >= 1.0%/6y 标准。解释：尽管 USPSTF 2021 资格标准比 USPSTF 2013 指南更敏感，但资格方面的性别差异仍然存在。将 PLCOm2012 风险预测模型添加到 USPSTF 指南中将提高敏感性并缩小性别差异。
BACKGROUND: Lung cancer is the leading cause of cancer death in women in the United States. Prospective randomized lung screening trials suggest a greater lung cancer mortality benefit from screening women compared with men.RESEARCH QUESTION: Do the United States Preventative Services Task Force (USPSTF) lung screening guidelines that are based solely on age and smoking history contribute to sex disparities in eligibility, and if so, does the use of the PLCOm2012 risk prediction model that is based on 11 predictors of lung cancer reduce sex disparities?STUDY DESIGN AND METHOD: This retrospective analysis of 883 lung cancer cases in the Chicago Race Eligibility for Screening Cohort (CREST) determined the sensitivity of USPSTF vs PLCOm2012 eligibility criteria, stratified according to sex. For comparisons vs the USPSTF 2013 and the recently published USPSTF 2021 (released March 9, 2021) eligibility criteria, the PLCOm2012 model was used with risk thresholds of >= 1.7%/6 years (6y) and >= 1.0%/6y, respectively.RESULT: The sensitivities for screening by the USPSTF 2013 were 46.7% for women and 64.6% for men (P = .003) and by the USPSTF 2021 were 56.8% and 71.8%, respectively (P = .02). In contrast, the PLCOm2012 >= 1.7%/6y sensitivities were 64.6% and 70.4%, and the PLCOm2012 >= 1.0%/6y sensitivities were 77.4% and 82.4%. The PLCOm2012 differences in sensitivity using >= 1.7%/6y and >= 1.0%/6y thresholds between women and men were nonsignificant (both, P = .07). Compared with men, women were more likely to be ineligible according to the USPSTF 2021 criteria because their smoking exposures were < 20 pack-years (22.8% vs 14.8%; ORwomen (vs) (Men), 1.70; 95% CI, 1.19-2.44; P = .002), and 27% of these ineligible women were eligible according to the PLCOm2012 >= 1.0%/6y criteria.INTERPRETATION: Although the USPSTF 2021 eligibility criteria are more sensitive than the USPSTF 2013 guidelines, sex disparities in eligibility remain. Adding the PLCOm2012 risk prediction model to the USPSTF guidelines would improve sensitivity and attenuate sex disparities.