Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia.
J Thorac Oncol. 2020 Jul;15(7):1160-1169. doi: 10.1016/j.jtho.2020.02.008. Epub 2020 Mar 8.
Annual lung cancer screening with low-dose computed tomography is recommended for adults aged 55 to 80 years with a greater than or equal to 30 pack-year smoking history who currently smoke or quit within the past 15 years. The 50% who are current smokers should be offered cessation interventions, but information about the impact of adding cessation to screening is limited.
We used an established lung cancer simulation model to compare the effects on mortality of a hypothetical one-time cessation intervention and annual screening versus annual screening only among screen-eligible individuals born in 1950 or 1960. Model inputs were derived from national data and included smoking history, probability of quitting with and without intervention, lung cancer risk and treatment effectiveness, and competing tobacco-related mortality. We tested the sensitivity of results under different assumptions about screening use and cessation efficacy.
Smoking cessation reduces lung cancer mortality and delays overall deaths versus screening only across all assumptions. For example, if screening was used by 30% of screen-eligible individuals born in 1950, adding an intervention with a 10% quit probability reduces lung cancer deaths by 14% and increases life years gained by 81% compared with screening alone. The magnitude of cessation benefits varied under screening uptake rates, cessation effectiveness, and birth cohort.
Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs. Evaluation of specific interventions, including costs and feasibility of implementation and dissemination, is needed to determine the best possible strategies and realize the full promise of lung cancer screening.
建议年龄在 55 岁至 80 岁之间、有大于或等于 30 包年吸烟史且目前仍在吸烟或在过去 15 年内已戒烟的成年人，每年用低剂量计算机断层扫描进行肺癌筛查。应该为目前仍在吸烟的 50%提供戒烟干预，但关于将戒烟干预措施加入到筛查中的效果的信息有限。
我们使用已建立的肺癌模拟模型，比较了在假设的一次性戒烟干预和每年筛查与仅每年筛查之间，对 1950 年或 1960 年出生的符合筛查条件的个体的死亡率的影响。模型输入数据来自国家数据，包括吸烟史、有无干预的戒烟概率、肺癌风险和治疗效果以及与烟草相关的竞争死亡率。我们测试了在不同的筛查使用和戒烟效果假设下，结果的敏感性。
与仅筛查相比，戒烟可降低肺癌死亡率并延迟所有死亡，在所有假设下均如此。例如，如果仅 30%的符合筛查条件的 1950 年出生者使用筛查，那么与仅筛查相比，增加一种具有 10%戒烟概率的干预措施可将肺癌死亡人数减少 14%，并增加 81%的预期寿命。戒烟效果的大小因筛查参与率、戒烟效果和出生队列而异。
戒烟干预措施有可能极大地增强肺癌筛查计划的效果。需要评估特定的干预措施，包括实施和传播的成本和可行性，以确定最佳策略并充分发挥肺癌筛查的潜力。
