Time to first cigarette and early detection in the National Lung Screening Trial

国家肺部筛查试验中首次吸烟的时间和早期发现

• 批准号: 9022934
• 负责人: JOSHUA E MUSCAT
• 金额: $ 7.74万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-23 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9022934
• 关键词: Accounting; Adult; Advisory Committees; Age; American; American Cancer Society; Behavior; Cancer Etiology; Carcinogen exposure; Carcinogens; Chest; Cigarette; Cigarette Smoker; Clinical Trials; Colorectal Cancer; Costs and Benefits; Data; Diagnosis; Dose; Early Diagnosis; Environment; Frequencies; Genetic; Goals; Hour; Individual; Lung; Lung Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Modeling; National Cancer Institute; Newly Diagnosed; Nicotine; Nicotine Dependence; Participant; Physicians; Preventive service; Progression-Free Survivals; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; Radiation; Recommendation; Recording of previous events; Relative Risks; Research; Risk; Risk Assessment; Risk Factors; Screening for Ovarian Cancer; Smoke; Smoker; Smoking; Smoking History; Staging; Survival Rate; Target Populations; Testing; Thoracic Radiography; Thoracic Surgical Procedures; Time; Tobacco-Associated Carcinogen; Tobacco-Related Carcinoma; United States; X-Ray Computed Tomography; cancer risk; clinical risk; college; cost; high risk; improved; inclusion criteria; low-dose spiral CT; lung cancer screening; mortality; predictive modeling; public health relevance; randomized trial; screening; trend; tumor; uptake

 DESCRIPTION (provided by applicant): The National Lung Screening Trial (NLST) of 53,454 current and former healthy smokers demonstrated that low dose computed tomography (LDCT) was effective in detecting lung tumors at an earlier stage and increasing survival from lung cancer. Lung cancer is by far the leading cause of cancer mortality, with a 5-year survival rate of about 17%. 5-year survival rate is about 54% for localized tumors, indicating that LDCT could substantially reduce mortality rates among the estimated annual 224,000 newly diagnosed cases. In December 2013, the United States Preventive Services Task Force (USTSPF) recommended annual screening with LDCT to adult smokers between the ages of 55 and 80. The risks associated with LDCT include false positives, radiation exposure, and the costs of screening. To improve the benefit/cost ratio, the USPSTF and the National Cancer Institute acknowledge that there is a need to identify additional lung cancer risk factors to better characterize the high risk target populations that would benefit from LDCT screening. The current study proposes to study the effects of a nicotine dependence behavior, the time to first cigarette (TFFC) after waking, on the early detection of lung cancer and overall survival time in the NLST. Recently, an early TTFC (within 15 minutes) has been shown to double the risk of all major histological types of lung cancer compared to smokers who waited an hour or more for their first cigarette. The association is dose-dependent, with a trend toward increasing risk with an earlier TTFC. The findings were independently replicated in several large-scale studies. The doubling of risk is observed among smokers, after careful adjustment for smoking history using a variety of models of cigarette exposure history. The mechanism underlying the association between TTFC and lung cancer appears to reflect the intensity of smoking, a critical determinant of tobacco carcinogen exposure that is not accounted for by standard smoking exposure measures such as duration and frequency. The TTFC is an equal if not better predictor of nicotine and carcinogen uptake in smokers than cigarettes per day, which explains its association with lung cancer risk, as well as with the risk of other tobacco-related cancers. A 30-pack year history of smoking was the inclusion criteria for the NLST, and is currently recommended for annual screening for lung cancer with low-dose CT. The NLST has collected information on TTFC in a subset of its participants, but the effect of TTFC on early detection has not yet been evaluated.

 描述（由申请人提供）：对 53,454 名当前和以前健康吸烟者进行的国家肺部筛查试验 (NLST) 表明，低剂量计算机断层扫描 (LDCT) 可以有效地早期发现肺部肿瘤并提高肺癌的生存率。肺癌是迄今为止癌症死亡的主要原因，其 5 年生存率为 约17%。局部肿瘤的 5 年生存率约为 54%，这表明 LDCT 可以大幅降低每年估计 224,000 例新诊断病例的死亡率。 2013 年 12 月，美国预防服务工作组 (USTSPF) 建议对 55 岁至 80 岁的成年吸烟者进行年度 LDCT 筛查。与 LDCT 相关的风险包括误报、辐射暴露和筛查费用。为了提高效益/成本比，USPSTF 和国家癌症研究所承认，有必要确定额外的肺癌风险因素，以更好地描述将从 LDCT 筛查中受益的高风险目标人群。目前的研究旨在研究尼古丁依赖行为、醒来后第一次吸烟的时间（TFFC）对肺癌早期发现和 NLST 总体生存时间的影响。最近，研究表明，与等待一个小时或更长时间才吸第一支烟的吸烟者相比，早期 TTFC（15 分钟内）患所有主要组织学类型肺癌的风险增加了一倍。这种关联是剂量依赖性的，早期 TTFC 的风险有增加的趋势。这些发现在几项大规模研究中得到了独立重复。使用各种香烟暴露史模型仔细调整吸烟史后，在吸烟者中观察到风险加倍。 TTFC 与肺癌之间关联的潜在机制似乎反映了吸烟强度，这是烟草致癌物暴露的关键决定因素，而标准吸烟暴露测量（例如持续时间和频率）并未考虑这一因素。与每天吸烟量相比，TTFC 是吸烟者尼古丁和致癌物摄入量的同等（甚至更好）预测指标，这解释了它与肺癌风险以及其他烟草相关癌症风险的关联。 30包年吸烟史是NLST的纳入标准，目前建议每年用低剂量CT筛查肺癌。 NLST 已收集了一部分参与者的 TTFC 信息，但 TTFC 对早期检测的影响尚未得到评估。