Brenner Hermann, Krilaviciute Agne
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany.
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany.
Cancers (Basel). 2020 Oct 16;12(10):3012. doi: 10.3390/cancers12103012.
Lung cancer (LC) screening often focuses heavy smokers as a target for screening group. Heavy smoking can thus be regarded as an LC pre-screening test with sensitivities and specificities being different in various populations due to the differences in smoking histories. We derive here expected sensitivities and specificities of various criteria to preselect individuals for LC screening in 27 European countries with diverse smoking prevalences. Sensitivities of various heavy-smoking-based pre-screening criteria were estimated by combining sex-specific proportions of people meeting these criteria in the target population for screening with associations of heavy smoking with LC risk. Expected specificities were approximated by the proportion of individuals not meeting the heavy smoking definition. Estimated sensitivities and specificities varied widely across countries, with sensitivities being generally higher among men (range: 33-80%) than among women (range: 9-79%), and specificities being generally lower among men (range: 48-90%) than among women (range: 70-99%). Major variation in sensitivities and specificities was also seen across different pre-selection criteria for LC screening within individual countries. Our results may inform the design of LC screening programs in European countries and serve as benchmarks for novel alternative or complementary tests for selecting people at high risk for CT-based LC screening.
肺癌（LC）筛查通常将重度吸烟者作为筛查对象。因此，重度吸烟可被视为一种肺癌预筛查测试，由于吸烟史不同，其在不同人群中的敏感度和特异度也有所差异。我们在此得出了在27个吸烟率各异的欧洲国家中，用于肺癌筛查预选择个体的各种标准的预期敏感度和特异度。通过将目标筛查人群中符合这些标准的特定性别人口比例与重度吸烟与肺癌风险的关联相结合，估算了各种基于重度吸烟的预筛查标准的敏感度。预期特异度通过未符合重度吸烟定义的个体比例来近似。各国的估算敏感度和特异度差异很大，男性的敏感度普遍高于女性（范围：33%-80%），女性为（范围：9%-79%）；男性的特异度普遍低于女性（范围：48%-90%），女性为（范围：70%-99%）。在各个国家内，不同的肺癌筛查预选择标准之间的敏感度和特异度也存在显著差异。我们的结果可为欧洲国家肺癌筛查项目的设计提供参考，并作为基于CT的肺癌筛查高危人群选择的新型替代或补充测试的基准。
