Preliminary Results of Lung Cancer Screening in a Socioeconomically Disadvantaged Population
Preliminary Results of Lung Cancer Screening in a Socioeconomically Disadvantaged Population
复制标题
DOI：
10.2214/ajr.17.18853
复制
发表时间：
2018-03-01
影响因子：
5
通讯作者：
Lee, Christopher
中科院分区：
文献类型：
--
作者：
Guichet, Phillip L.;Liu, Beringia Y.;Lee, Christopher
OBJECTIVE.本研究的目的是描述我们的临床低剂量CT（LDCT）肺癌筛查计划的初步结果，该计划针对的是少数、社会经济弱势、高危人群，与国家肺筛查试验（NLST）中研究的人群不同。南洛杉矶县一个服务不足地区的社区合作诊所将感兴趣的候选人推荐给我们的计划。所有患者均符合国家综合癌症网络肺癌筛查的合格标准。从2015年7月21日到2017年4月3日，共有889人被转介到该计划。在329名符合条件的参与者中，275名（平均年龄59岁，52%为男性）接受了基线LDCT筛查：84%的患者为黑人，66%的患者为高中或以下学历，中位吸烟包年数为40，81%的患者目前吸烟。31%的参与者报告职业暴露于一种或多种已知的肺癌致癌物。使用基线LDCT检查分配肺部CT筛查报告和数据系统（Lung-RADS）类别：86%的患者分配了Lung-RADS 1或2类，7%分配了3类，4%分配了4A类，3%分配了4 B或4X类。迄今为止，这些患者中有2例（0.7%）被诊断为肺癌：1例患者为IIIB期小细胞肺癌，另1例患者为IV期未知类型肺癌。在275例患者中，29%的患者有潜在的临床意义的偶然发现。在少数社会经济弱势的高危人群中进行LDCT肺癌筛查是可行的，但可能会产生与更优越社区的筛查人群不同的肺癌特征。需要更多的随访时间来确定NLST中显示的肺癌死亡率降低是否适用于这一服务不足的人群。
OBJECTIVE. The objective of our study was to describe the preliminary results of our clinical low-dose CT (LDCT) lung cancer screening program targeting a minority, socio-economically disadvantaged, high-risk population different from that studied in the National Lung Screening Trial (NLST).MATERIALS AND METHODS. Community partner clinics in an underserved region of south Los Angeles County referred interested candidates to our program. All patients met National Comprehensive Cancer Network eligibility criteria for lung cancer screening.RESULTS. From July 21, 2015, through April 3, 2017, 889 individuals were referred to the program. Of the 329 eligible participants, 275 (mean age, 59 years; 52% men) underwent baseline screening LDCT: 84% of patients were black, and 66% had a high school education or less. The median pack-years was 40, and 81% of patients were current smokers. Thirty-one percent of participants reported occupational exposure to one or more known lung carcinogens. Lung CT Screening Reporting and Data System (Lung-RADS) categories were assigned using baseline LDCT examinations: Lung-RADS category 1 or 2 were assigned in 86% of patients, category 3 in 7%, category 4A in 4%, and category 4B or 4X in 3%. Lung cancer has been diagnosed in two of these patients (0.7%) to date: stage IIIB small cell lung carcinoma in one patient and stage IV lung cancer of unknown type in the other patient. Among the 275 patients, 29% had potentially clinically significant incidental findings.CONCLUSION. Lung cancer screening with LDCT in a minority, socioeconomically disadvantaged, high-risk population is feasible but may yield a different lung cancer profile than screening populations in more privileged communities. More follow-up time is required to determine whether the reduction in lung cancer mortality shown in the NLST applies to this underserved population.