Nemesure Barbara, Plank April, Reagan Lisa, Albano Denise, Reiter Michael, Bilfinger Thomas V
1 Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, USA.
2 Department of Radiology, Stony Brook Medicine, Stony Brook, USA.
J Med Screen. 2017 Dec;24(4):208-213. doi: 10.1177/0969141316689111. Epub 2017 Feb 15.
Objective Current lung cancer screening criteria based primarily on outcomes from the National Lung Screening Trial may not adequately capture all subgroups of the population at risk. We aimed to evaluate the efficacy of lung cancer screening criteria recommended by the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and the National Comprehensive Cancer Network in identifying known cases of lung cancer. Methods An investigation of the Stony Brook Cancer Center Lung Cancer Evaluation Center's database identified 1207 eligible, biopsy-proven lung cancer cases diagnosed between January 1996 and March 2016. Age at diagnosis, smoking history, and other known risk factors for lung cancer were used to determine the proportion of cases that would have met current United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility requirements for lung cancer screening. Results Of the 1046 ever smokers in the study, 40% did not meet the National Lung Screening Trial age requirements, 20% did not have a ≥30 pack year smoking history, and approximately one-third quit smoking >15 years before diagnosis, thus deeming them ineligible for screening. Applying the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility criteria to the Stony Brook Cancer Center's Lung Cancer Evaluation Center cases, 49.2, 46.3, and 69.8%, respectively, would have met the current lung cancer screening guidelines. Conclusions The United States Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility criteria for lung cancer screening captured less than 50% of lung cancer cases in this investigation. These findings highlight the need to reevaluate the efficacy of current guidelines and may have major public health implications.
目的 目前主要基于国家肺癌筛查试验结果制定的肺癌筛查标准可能无法充分涵盖所有高危人群亚组。我们旨在评估美国预防服务工作组、医疗保险和医疗补助服务中心以及美国国立综合癌症网络推荐的肺癌筛查标准在识别已知肺癌病例方面的效果。方法 对石溪癌症中心肺癌评估中心的数据库进行调查，确定了1996年1月至2016年3月期间诊断的1207例经活检证实的符合条件的肺癌病例。根据诊断时的年龄、吸烟史和其他已知的肺癌危险因素，确定符合美国预防服务工作组、医疗保险和医疗补助服务中心以及美国国立综合癌症网络当前肺癌筛查资格要求的病例比例。结果 在该研究的1046名曾经吸烟的人中，40%不符合国家肺癌筛查试验的年龄要求，20%没有≥30包年的吸烟史，约三分之一在诊断前15年以上戒烟，因此被认为不符合筛查条件。将美国预防服务工作组、医疗保险和医疗补助服务中心以及美国国立综合癌症网络的资格标准应用于石溪癌症中心肺癌评估中心的病例，分别有49.2%、46.3%和69.8%的病例符合当前肺癌筛查指南。结论 在美国预防服务工作组和医疗保险和医疗补助服务中心的肺癌筛查资格标准下，本次调查中不到50%的肺癌病例符合要求。这些发现凸显了重新评估现行指南效果的必要性，可能对公共卫生产生重大影响。
