Rampinelli Cristiano, De Marco Paolo, Origgi Daniela, Maisonneuve Patrick, Casiraghi Monica, Veronesi Giulia, Spaggiari Lorenzo, Bellomi Massimo
Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Milan, Italy
Medical Physics School, University of Milan, Milan, Italy.
BMJ. 2017 Feb 8;356:j347. doi: 10.1136/bmj.j347.
To estimate the cumulative radiation exposure and lifetime attributable risk of cancer incidence associated with lung cancer screening using annual low dose computed tomography (CT). Secondary analysis of data from a lung cancer screening trial and risk-benefit analysis. 10 year, non-randomised, single centre, low dose CT, lung cancer screening trial (COSMOS study) which took place in Milan, Italy in 2004-15 (enrolment in 2004-05). Secondary analysis took place in 2015-16. High risk asymptomatic smokers aged 50 and older, who were current or former smokers (≥20 pack years), and had no history of cancer in the previous five years. Cumulative radiation exposure from low dose CT and positron emission tomography (PET) CT scans, calculated by dosimetry software; and lifetime attributable risk of cancer incidence, calculated from the (BEIR VII) report. Over 10 years, 5203 participants (3439 men, 1764 women) underwent 42 228 low dose CT and 635 PET CT scans. The median cumulative effective dose at the 10th year of screening was 9.3 mSv for men and 13.0 mSv for women. According to participants' age and sex, the lifetime attributable risk of lung cancer and major cancers after 10 years of CT screening ranged from 5.5 to 1.4 per 10 000 people screened, and from 8.1 to 2.6 per 10 000 people screened, respectively. In women aged 50-54, the lifetime attributable risk of lung cancer and major cancers was about fourfold and threefold higher than for men aged 65 and older, respectively. The numbers of lung cancer and major cancer cases induced by 10 years of screening in our cohort were 1.5 and 2.4, respectively, which corresponded to an additional risk of induced major cancers of 0.05% (2.4/5203). 259 lung cancers were diagnosed in 10 years of screening; one radiation induced major cancer would be expected for every 108 (259/2.4) lung cancers detected through screening. Radiation exposure and cancer risk from low dose CT screening for lung cancer, even if non-negligible, can be considered acceptable in light of the substantial mortality reduction associated with screening.
评估使用年度低剂量计算机断层扫描（CT）进行肺癌筛查相关的累积辐射暴露以及癌症发病的终生归因风险。对肺癌筛查试验数据进行二次分析及风险效益分析。2004年至2015年（2004年至2005年入组）在意大利米兰开展的一项为期10年的非随机、单中心、低剂量CT肺癌筛查试验（COSMOS研究）。二次分析于2015年至2016年进行。年龄在50岁及以上的高危无症状吸烟者，为现吸烟者或既往吸烟者（≥20包年），且在过去五年内无癌症病史。通过剂量测定软件计算低剂量CT和正电子发射断层扫描（PET）CT扫描的累积辐射暴露；并根据（BEIR VII）报告计算癌症发病的终生归因风险。在10年期间，5203名参与者（3439名男性，1764名女性）接受了42228次低剂量CT扫描和635次PET CT扫描。筛查第10年时，男性的中位累积有效剂量为9.3毫希沃特，女性为13.0毫希沃特。根据参与者的年龄和性别，CT筛查10年后肺癌和主要癌症的终生归因风险分别为每10000名筛查者中5.5至1.4例，以及每10000名筛查者中8.1至2.6例。在50至54岁的女性中，肺癌和主要癌症的终生归因风险分别比65岁及以上男性高约四倍和三倍。我们队列中10年筛查导致的肺癌和主要癌症病例数分别为1.5例和2.4例，这相当于诱发主要癌症的额外风险为0.05%（2.4/5203）。在10年筛查中诊断出259例肺癌；通过筛查检测到的每108例（259/2.4）肺癌中预计会有1例辐射诱发的主要癌症。肺癌低剂量CT筛查的辐射暴露和癌症风险，即使不可忽略，但鉴于筛查带来的显著死亡率降低，可被认为是可接受的。
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