Ann Intern Med. 2014 Mar 4;160(5):311-20. doi: 10.7326/M13-2316.
The optimum screening policy for lung cancer is unknown.
To identify efficient computed tomography (CT) screening scenarios in which relatively more lung cancer deaths are averted for fewer CT screening examinations.
Comparative modeling study using 5 independent models.
The National Lung Screening Trial; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial; the Surveillance, Epidemiology, and End Results program; and the U.S. Smoking History Generator.
U.S. cohort born in 1950.
Cohort followed from ages 45 to 90 years.
Societal.
576 scenarios with varying eligibility criteria (age, pack-years of smoking, years since quitting) and screening intervals.
Benefits included lung cancer deaths averted or life-years gained. Harms included CT examinations, false-positive results (including those obtained from biopsy/surgery), overdiagnosed cases, and radiation-related deaths.
RESULTS OF BEST-CASE SCENARIO: The most advantageous strategy was annual screening from ages 55 through 80 years for ever-smokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting. It would lead to 50% (model ranges, 45% to 54%) of cases of cancer being detected at an early stage (stage I/II), 575 screening examinations per lung cancer death averted, a 14% (range, 8.2% to 23.5%) reduction in lung cancer mortality, 497 lung cancer deaths averted, and 5250 life-years gained per the 100,000-member cohort. Harms would include 67,550 false-positive test results, 910 biopsies or surgeries for benign lesions, and 190 overdiagnosed cases of cancer (3.7% of all cases of lung cancer [model ranges, 1.4% to 8.3%]).
The number of cancer deaths averted for the scenario varied across models between 177 and 862; the number of overdiagnosed cases of cancer varied between 72 and 426.
Scenarios assumed 100% screening adherence. Data derived from trials with short duration were extrapolated to lifetime follow-up.
Annual CT screening for lung cancer has a favorable benefit-harm ratio for individuals aged 55 through 80 years with 30 or more pack-years' exposure to smoking.
National Cancer Institute.
肺癌的最佳筛查策略尚不清楚。
确定更有效的计算机断层扫描（CT）筛查方案，以便在进行较少的 CT 筛查检查时能更有效地预防肺癌死亡。
使用 5 个独立模型进行比较建模研究。
国家肺癌筛查试验；前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验；监测、流行病学和最终结果计划；以及美国吸烟史生成器。
1950 年出生的美国队列。
从 45 岁到 90 岁的队列随访。
社会。
有 576 种不同的入选标准（年龄、吸烟包年数、戒烟年限）和筛查间隔的情景。
效益包括预防肺癌死亡或延长生命年。危害包括 CT 检查、假阳性结果（包括活检/手术获得的结果）、过度诊断病例和与辐射相关的死亡。
最有利的策略是对至少吸烟 30 包年的终身吸烟者和戒烟时间少于 15 年的前吸烟者，从 55 岁到 80 岁进行每年一次的筛查。这将导致 50%（模型范围，45%至 54%）的癌症病例在早期（I/II 期）被发现，每预防一例肺癌死亡需进行 575 次筛查检查，肺癌死亡率降低 14%（范围，8.2%至 23.5%），预防 497 例肺癌死亡，每 10 万名成员队列增加 5250 个生命年。危害将包括 67550 例假阳性检测结果、910 例良性病变活检或手术以及 190 例癌症过度诊断病例（所有肺癌病例的 3.7%[模型范围，1.4%至 8.3%]）。
该方案预防的癌症死亡人数在不同模型中从 177 例到 862 例不等；过度诊断的癌症病例数从 72 例到 426 例不等。
方案假设 100%的筛查依从性。从持续时间短的试验中得出的数据被推断为终生随访。
对于吸烟 30 包年或以上、年龄在 55 岁至 80 岁之间的个体，每年进行 CT 筛查可带来有利的效益-危害比。
美国国立癌症研究所。
