Comparative Modeling of Lung Cancer Prevention and Control Policies

 描述(申请人提供)：在美国，肺癌是头号癌症杀手，吸烟仍然是头号可预防的死亡原因。此外，吸烟和肺癌的主要差异存在于教育、收入和种族/民族方面。虽然烟草控制政策是预防肺癌的最有效策略，但肺癌计算机断层扫描(CT)筛查也被证明可以降低目前大量吸烟者和以前吸烟者患肺癌的风险。癌症干预和监测模型网络(CISNET)肺科小组开发和应用肺癌人口模型，量化烟草控制和CT筛查对肺癌和全因死亡率的影响。到目前为止，这项工作侧重于整个国家，尚未按分组和区域说明烟草和肺癌的差异。这项拟议的工作将扩展现有的CISNET肺部模型，以调查美国和中等收入国家烟草控制政策和肺癌筛查的协同影响，重点关注吸烟行为和肺癌风险的差异。吸烟和肺癌模型将纳入其他反映不同吸烟风险的因素，如种族/民族、教育程度、收入和地理位置。这将有助于分析烟草控制政策对相关高危人群中美国吸烟流行率的影响，并估计政策对吸烟和肺癌结果的健康差异的影响。模型还将适用于墨西哥和泰国这两个中等收入国家，以评估烟草控制政策对人口和吸烟行为特征与美国不同的中等收入国家吸烟和肺癌发病率的影响。尽管肺癌筛查现在得到了USPSTF和其他主要国家组织的支持，但在人群水平上筛查的潜在好处和危害仍然存在相当大的争论。该项目将扩展CISNet肺癌筛查模型，以评估肺癌筛查实施、保险覆盖范围和对建议的人口健康方案的遵守情况的异质性的后果。还将使用模型来调查将替代性个人风险预测措施作为筛查资格标准的影响，并对当前和替代性筛查建议进行成本效益分析，目的是确定人口一级的最佳战略。

 DESCRIPTION (provided by applicant): Lung cancer is the top cancer killer and smoking remains the leading preventable cause of death in the US. Furthermore, major disparities in smoking and lung cancer exist by education, income, and race/ethnicity. While tobacco control policies are the most effective strategies to prevent lung cancers, lung cancer computed tomography (CT) screening has also been shown to reduce lung cancer risk among heavy current and former smokers. The Cancer Intervention and Surveillance Modeling Network (CISNET) lung group develops and applies population models for lung cancer, quantifying the impact of tobacco control and CT screening on lung cancer and all-cause mortality. To date, this work has focused on the country as a whole and has yet to account for tobacco and lung cancer disparities by subgroup and region. This proposed work will extend existing CISNET lung models to investigate the synergistic impacts of tobacco control policies and lung cancer screening in the US and in middle-income nations, focusing on disparities in both smoking behavior and lung cancer risk. The smoking and lung cancer models will incorporate other factors that reflect different smoking risks such as race/ethnicity, education, income, and geographic location. This will allow for analyses of the effects of tobacco control policies on US smoking prevalence in relevant high-risk groups, and estimation of the impact of policies on health disparities in smoking and lung cancer outcomes. Models will also be adapted for two middle-income nations, Mexico and Thailand, to evaluate the impact of tobacco control policies on smoking and lung cancer rates in middle-income countries with different demographic and smoking behavior profiles than the US. Although lung cancer screening is now supported by the USPSTF and other major national organizations, there is still considerable debate over the potential benefits and harms of screening at the population level. This project will extend CISNET lung cancer screening models to assess the consequences of heterogeneity in lung cancer screening implementation, insurance coverage, and compliance with recommended protocols on population health. Models will also be used to investigate the implications of using alternative individual risk prediction measures as eligibility criteria for screening, and to perfom cost-effectiveness analyses of current and alternative screening recommendations, with the goal of identifying optimal strategies at the population level.