Evaluating Lung Cancer Screening Patterns and Outcomes in Diverse Populations and Settings

摘要 肺癌是美国癌症死亡的主要原因， 黑人与白色男性相比，尽管黑人人口的吸烟率较低， 白天，不太可能吸烟。随机试验证明肺癌的早期检测 每年低剂量计算机断层扫描可使高危人群的肺癌死亡率降低20-33%。 2013年，美国预防服务工作组（USPSTF）建议每年进行肺癌筛查（LCS）。 年龄在55-80岁之间，目前或以前（15年内戒烟）吸烟至少30包-年的个体。 一些研究表明，2013年USPSTF LCS资格标准根据选定的妇女和黑人个人 吸烟倾向较低但患肺癌的风险增加。2021年，USPSTF 扩大了他们的LCS建议，包括年龄在50-80岁之间的个人，至少20包年 历史上，合格人数增加了80%以上，达到1450万美国成年人。这些扩展标准 将导致女性与男性和非西班牙裔黑人相比， 与非西班牙裔白色人群相比。然而，扩大2021年USPSTF资格标准对 筛查实践和结果未知。本申请的目的是了解 更新的2021年USPSTF LCS建议在实践中得到实施，并量化了新的 关于LCS护理从坚持到表现的连续性的建议。我们的核心假设是， 在新的合格个体中，LCS的益处和危害将存在基于种族和性别的差异 (e.g.,年龄50-54岁或吸烟20-29 P-Y），因为发生肺结核的基线风险存在异质性。 癌在强有力的初步数据的指导下，将通过以下具体方法来检验假设： 目的：1）评估患者和临床医生对2021年扩大的 USPSTF LCS建议; 2）确定2013年与2021年USPSTF LCS资格标准的影响 在筛查护理连续体中，（a）筛查人群的基线肺癌风险，（B） 遵守年度LCS，以及（c）在异常LCS结果后接受推荐的护理;以及3） 比较LDCT LCS在根据USPSTF 2013标准和2021标准筛查的个体中的性能 新的合格标准。这项研究是创新的，在一个大的，多样化的， 以社区为基础的人群，以评估2021年USPSTF LCS建议对LCS护理的影响 模式和结果。这项研究是有意义的，因为它将量化LCS的经验， 现在有1450万人有资格接受筛查。这些发现有望推动和扩大我们的研究。 了解LCS在不同人群和环境中的作用，这将使临床医生能够提供更多证据 高质量的LCS护理。

ABSTRACT Lung cancer is the leading cause of cancer deaths in the United States, with higher rates of lung cancer among Black versus White men, despite Black populations having lower smoking rates, smoking fewer cigarettes per day, and being less likely to smoke heavily. Randomized trials demonstrated early detection of lung cancer with annual low dose computed tomography reduces lung cancer mortality by 20-33% in high-risk populations. In 2013 the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) in individuals ages 55-80 years who currently or former (quit within 15 years) smoked at least 30 pack-years. Some studies suggested the 2013 USPSTF LCS eligibility criteria under selected women and Black individuals who tend to smoke less intensely yet have increased risk of developing lung cancer. In 2021, the USPSTF expanded their LCS recommendations to include individuals ages 50-80 years with at least a 20 pack-year history, increasing the number eligible by more than 80% to 14.5 million U.S. adults. These expanded criteria will result in higher relative increases in screening eligibility for women versus men and non-Hispanic Black versus non-Hispanic White populations. Yet, the impact of the expanded 2021 USPSTF eligibility criteria on screening practice and outcomes is unknown. The objective of this application is to understand how the updated 2021 USPSTF LCS recommendations are implemented in practice and quantify the impact of the new recommendations on the LCS care continuum from adherence to performance. Our central hypothesis is that there will be race and sex-based differences in the benefits and harms of LCS among newly eligible individuals (e.g., ages 50-54 years or smoking 20-29 P-Y) because of heterogeneity in the baseline risk of developing lung cancer. Guided by strong preliminary data, the hypothesis will be tested by pursuing the following specific aims: 1) Evaluate patients’ and clinicians' attitudes, knowledge, and experiences with the expanded 2021 USPSTF LCS recommendations; 2) Determine the impact of the 2013 vs. 2021 USPSTF LCS eligibility criteria across the screening care continuum in terms of (a) baseline lung cancer risk in the population screened, (b) adherence to annual LCS, and (c) receipt of recommended care following an abnormal LCS result; and 3) Compare the performance of LDCT LCS in individuals screened per the USPSTF 2013 criteria versus the 2021 newly eligible criteria. The study is innovative in combining survey and quantitative methods in a large, diverse, community-based population to evaluate the impact of the 2021 USPSTF LCS recommendations on LCS care patterns and outcomes. The proposed research is significant because it will quantify the experiences of LCS in the 14.5 million individuals now eligible for screening. The findings are expected to advance and expand our understanding of LCS in diverse populations and settings which will enable clinicians to deliver more evidence based, high-quality LCS care.