根据自我报告的吸烟状况遵守一般体检和癌症筛查指南的情况：韩国国家健康和营养检查调查（KNHANES）2010-2012 年。
Adherence to general medical checkup and cancer screening guidelines according to self-reported smoking status: Korea National Health and Nutrition Examination Survey (KNHANES) 2010-2012.
机构信息
Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
Department of Information and Statistics, Korea National Open University, Seoul, South Korea.
出版信息
PLoS One. 2019 Oct 22;14(10):e0224224. doi: 10.1371/journal.pone.0224224. eCollection 2019.
OBJECTIVES
The National Lung Screening Trial (NLST) revealed that low-dose computed tomography (LDCT) screening could reduce lung cancer mortality in heavy smokers. Lung screening with LDCT was implemented in July 2019 as part of the National Cancer Screening Program in Korea for heavy smokers who meet NLST criteria [smokers aged 55-74 years with 30 pack-years (PY) or more, excluding former smokers with more than 15 years since smoking cessation]. This study evaluated NLST-eligible heavy smokers' adherence to general medical checkup and cancer screening guidelines.
METHODS
Using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012, we compared adherence of Korean adults (55-74 years, n = 5,480) to general medical checkup and cancer (gastric, colorectal, breast, and cervical) screening guidelines according to self-reported smoking status. Smoking and PY data were available, but no data indicating when former smokers ceased smoking were available. Accordingly, smoking status was only classified as NLST (smokers with a history ≥ 30 PY) and non-NLST. Individuals who met NLST criteria were subdivided into current (NLST-current) and former smokers (NLST-former). Multivariable logistic regression was used to evaluate adherence to screening recommendations as a function of the study group (NLST-current, NLST-former, non-NLST) using possible covariates (sociodemographic factors, health-related behaviors, comorbidities, and self-reported health status).
RESULTS
Weighted prevalence of NLST-current was 9.7%, of NLST-former was 9.6%, and of non-NLST was 80.7%. Overall screening rates were 70.7% (medical checkup), 59.1% (stomach cancer), 58.1% (colorectal cancer), 59.1% (breast cancer), and 48.9% (cervical cancer). Adherence to colorectal cancer screening and medical checkup was lower in NLST-current than non-NLST (AOR 0.59; 95% CI 0.44-0.78 for colorectal cancer; AOR 0.70; 95% CI 0.52-0.95 for medical checkup). Screening practices for other cancers were not different.
CONCLUSIONS
Current heavy smokers meeting NLST criteria were less likely to have colorectal cancer screening or general medical checkup. Understanding the screening practices of this target population might enable the development of more effective plans to implement lung screening and improve screening compliance for other cancers.
目的
国家肺癌筛查试验（NLST）显示，低剂量计算机断层扫描（LDCT）筛查可以降低重度吸烟者的肺癌死亡率。自 2019 年 7 月起，LDCT 肺部筛查作为韩国国家癌症筛查计划的一部分，纳入符合 NLST 标准的重度吸烟者[年龄在 55-74 岁、吸烟 30 包年（PY）或以上、戒烟 15 年以上的前吸烟者除外]。本研究评估了符合 NLST 标准的重度吸烟者对一般医疗检查和癌症筛查指南的依从性。
方法
利用 2010 年至 2012 年的韩国国家健康和营养调查（KNHANES）数据，我们根据自我报告的吸烟状况，比较了韩国成年人（55-74 岁，n=5480）对一般医疗检查和癌症（胃癌、结直肠癌、乳腺癌和宫颈癌）筛查指南的依从性。吸烟和 PY 数据是可用的，但没有关于以前吸烟者何时戒烟的数据。因此，仅将吸烟状况分为 NLST（有≥30 PY 吸烟史者）和非 NLST。符合 NLST 标准的个体进一步分为当前吸烟者（NLST 当前）和前吸烟者（NLST 前）。使用可能的协变量（社会人口统计学因素、健康相关行为、合并症和自我报告的健康状况），多变量逻辑回归评估了作为研究组（NLST 当前、NLST 前、非 NLST）的筛查建议的依从性。
结果
NLST 当前的加权患病率为 9.7%，NLST 前的为 9.6%，非 NLST 的为 80.7%。总体筛查率为 70.7%（体检）、59.1%（胃癌）、58.1%（结直肠癌）、59.1%（乳腺癌）和 48.9%（宫颈癌）。与非 NLST 相比，NLST 当前的结直肠癌筛查和体检依从性较低（结直肠癌的比值比[OR]为 0.59；95%置信区间[CI]为 0.44-0.78；体检的 OR 为 0.70；95% CI 为 0.52-0.95）。其他癌症的筛查情况没有差异。
结论
符合 NLST 标准的当前重度吸烟者进行结直肠癌筛查或一般医疗检查的可能性较低。了解这一目标人群的筛查实践情况，可能有助于制定更有效的计划来实施肺癌筛查，并提高其他癌症的筛查依从性。
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