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，其中肺癌的发病率较高 黑人与白人男性相比，尽管黑人吸烟率较低，但平均每人吸烟较少 白天，不太可能大量吸烟。随机试验证实肺癌的早期检测 通过年度低剂量计算机断层扫描，高危人群的肺癌死亡率降低了20%-33%。 2013年，美国预防服务工作组(USPSTF)建议每年进行一次肺癌筛查(LCS) 年龄55-80岁，现任或前任(15年内戒烟)吸烟至少30包年的个人。 一些研究表明，2013年USPSTF LCS资格标准是根据选定的女性和黑人个人制定的 吸烟强度较小，但患肺癌风险增加的人。2021年，USPSTF 扩大了他们的LCS推荐范围，将年龄在50-80岁之间、至少有20个包年的个人包括在内 符合条件的人数增加了80%以上，达到1,450万美国成年人。这些扩展的标准 将导致女性相对于男性和非西班牙裔黑人的筛查资格相对增加更多 与非西班牙裔白人人口的对比。然而，扩大的2021年USPSTF资格标准对 筛查的做法和结果尚不清楚。本应用程序的目标是了解 更新的2021年USPSTF LCS建议在实践中得到实施，并量化了新建议的影响 关于从坚持到绩效的LCS护理连续体的建议。我们的中心假设是 在新符合资格的个人中，LCS的益处和危害将基于种族和性别的差异 (例如，50-54岁或吸烟20-29 P-Y)，因为发生肺部疾病的基线风险的异质性 癌症。在强劲的初步数据的指导下，将通过追求以下具体数据来检验该假说 目标：1)评估患者和临床医生对扩展的2021年的态度、知识和经验 USPSTF LCS建议；2)确定2013年与2021年USPSTF LCS资格标准的影响 在整个筛查护理连续过程中：(A)筛查人群中的基线肺癌风险，(B) 遵守年度LCS，以及(C)在LCS结果异常后接受推荐护理；和3) 比较LDCT LCS在根据USPSTF 2013标准筛查的个人与2021年筛查的个人中的表现 新的合格标准。这项研究在将调查和定量方法相结合方面具有创新性， 以社区为基础的人群评估2021年USPSTF LCS建议对LCS护理的影响 模式和结果。拟议的研究具有重要意义，因为它将量化LCS在 现在有资格进行筛查的1450万人。预计这些发现将推动和扩大我们的 了解不同人群和环境中的LCS，将使临床医生能够提供更多证据 基于高质量的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.