Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: Modeling Study for the US Preventive Services Task Force.
Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: Modeling Study for the US Preventive Services Task Force.
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DOI：
10.1001/jama.2021.1077
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发表时间：
2021-03-09
影响因子：
120.7
通讯作者：
Kong, Chung Yin
中科院分区：
文献类型：
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作者：
Meza, Rafael;Jeon, Jihyoun;Toumazis, Iakovos;ten Haaf, Kevin;Cao, Pianpian;Bastani, Mehrad;Han, Summer S.;Blom, Erik F.;Jonas, Daniel E.;Feuer, Eric J.;Plevritis, Sylvia K.;de Koning, Harry J.;Kong, Chung Yin
美国预防服务工作组（USPSTF）正在更新其2013年肺癌筛查指南，该指南建议每年对55至80岁的成年人进行筛查，这些人至少有30包年的吸烟史，目前吸烟或在过去15年内戒烟。通过评估各种低剂量计算机断层扫描（LDCT）筛查策略的获益和危害，为USPSTF指南提供信息。比较模拟建模与4个肺癌自然史模型的个人从1950年和1960年美国出生队列，从45岁到90岁。不同起始年龄、终止年龄和筛查频率的筛查。资格标准基于年龄、累积包年数和戒烟年数（基于风险因素），或基于年龄和使用具有不同资格阈值的风险预测模型进行的个体肺癌风险估计（基于风险模型）。总共对1092个策略进行了建模。假设所有情况下都能充分吸收和遵守。益处：与不筛查相比，估计肺癌死亡避免和生命年增加。危害：估计一生中LDCT筛查次数、假阳性结果、活检、过度诊断病例和辐射相关肺癌死亡。有效的筛选程序，估计产生最大的好处，为给定数量的屏幕被确定。大多数有效的基于风险因素的策略在50岁或55岁时开始筛查，并在80岁时停止。2013年USPSTF推荐的标准并不是1960年出生队列的有效策略。年度战略与20包年的最低标准是有效的，与目前的标准相比，估计增加资格（20.6%至23.6% vs 14.1%的人群符合条件），避免了肺癌死亡（469至558 vs 381/100，000），生命年增加（6，018至7，596 vs 4，882/100，000）。然而，这些策略估计会导致更多的假阳性检测（1.9至2.5对1.9/人筛查），过度诊断病例（83至94对69/10万）和辐射相关的肺癌死亡（29.0至42.5对20.6/10万）。据估计，基于风险模型的战略与基于风险因素的战略相比，获益更高，与辐射相关的死亡更少，但过度诊断病例更多。微观模拟模型研究表明，LDCT筛查肺癌与不筛查相比，在最佳靶向和实施时，可能会增加肺癌死亡的避免和生命年的增加。据估计，对年龄在50岁或55岁至80岁之间、吸烟暴露量在20包-年或以上的个体进行筛查，比目前的标准带来更多的益处，并且按性别和种族/民族划分的合格性差异较小。
The US Preventive Services Task Force (USPSTF) is updating its 2013 lung cancer screening guidelines, which recommend annual screening in adults aged 55 through 80 years who have at least a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. To inform the USPSTF guidelines by estimating the benefits and harms associated with various low-dose computed tomography (LDCT) screening strategies. Comparative simulation modeling with 4 lung cancer natural history models for individuals from the 1950 and 1960 US birth cohorts followed from ages 45 to 90 years. Screening with varying starting ages, stopping ages, and screening frequency. Eligibility criteria based on age, cumulative pack-years, and years since quitting smoking (risk factor–based), or on age and individual lung cancer risk estimation using risk prediction models with varying eligibility thresholds (risk model–based). A total of 1092 strategies were modeled. Full uptake and adherence were assumed for all scenarios. Benefits: Estimated lung cancer deaths averted and life-years gained compared with no screening. Harms: Estimated lifetime number of LDCT screens, false-positive results, biopsies, overdiagnosed cases, and radiation-related lung cancer deaths. Efficient screening programs estimated to yield the most benefits for a given number of screens were identified. Most of the efficient risk factor–based strategies started screening at age 50 or 55 and stopped at age 80. The 2013 USPSTF-recommended criteria were not among the efficient strategies for the 1960 birth cohort. Annual strategies with a 20 pack-years minimum criterion were efficient and compared with the current criteria were estimated to increase eligibility (20.6% to 23.6% vs 14.1% of the population ever eligible), lung cancer deaths averted (469 to 558 vs 381 per 100,000), and life-years gained (6,018 to 7,596 vs 4,882 per 100,000). However, these strategies were estimated to result in more false-positive tests (1.9 to 2.5 vs 1.9 per person screened), overdiagnosed cases (83 to 94 vs 69 per 100,000), and radiation-related lung cancer deaths (29.0 to 42.5 vs 20.6 per 100,000). Risk model–based vs risk factor–based strategies were estimated to be associated with higher benefits and fewer radiation-related deaths, but more overdiagnosed cases. Microsimulation modeling studies suggested that LDCT screening for lung cancer compared with no screening may increase lung cancer deaths averted and life-years gained when optimally targeted and implemented. Screening individuals aged 50 or 55 through age 80 with 20 or more pack-years of smoking exposure was estimated to result in more benefits than current criteria and less disparity in eligibility by sex and race/ethnicity.
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DOI：
10.1093/jnci/djs136
发表时间：
2012-04-04
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Moolgavkar SH;Holford TR;Levy DT;Kong CY;Foy M;Clarke L;Jeon J;Hazelton WD;Meza R;Schultz F;McCarthy W;Boer R;Gorlova O;Gazelle GS;Kimmel M;McMahon PM;de Koning HJ;Feuer EJ
通讯作者：
Feuer EJ
影响因子：
39.2
作者：
Moyer, Virginia A.
通讯作者：
Moyer, Virginia A.
影响因子：
6.2
作者：
Meza, Rafael;ten Haaf, Kevin;Kong, Chung Yin;Erdogan, Ayca;Black, William C.;Tammemagi, Martin C.;Choi, Sung Eun;Jeon, Jihyoun;Han, Summer S.;Munshi, Vidit;van Rosmalen, Joost;Pinsky, Paul;McMahon, Pamela M.;de Koning, Harry J.;Feuer, Eric J.;Hazelton, William D.;Plevritis, Sylvia K.
通讯作者：
Plevritis, Sylvia K.
影响因子：
20.4
作者：
Aberle, Denise R.;Black, William C.;Sicks, JoRean D.
通讯作者：
Sicks, JoRean D.
影响因子：
4.7
作者：
Holford, Theodore R.;Levy, David T.;Meza, Rafael
通讯作者：
Meza, Rafael