Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA.
Departments of Radiology and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
J Natl Cancer Inst. 2021 Aug 2;113(8):1044-1052. doi: 10.1093/jnci/djaa170.
Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018.
The American College of Radiology's Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year.
Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation's highest lung cancer mortality rate and one of the highest SRs (13.7%).
Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.
自 2013 年以来，一直建议在年龄较大的当前和曾经的吸烟者（即符合条件的成年人）中进行年度肺癌筛查（LCS），并使用低剂量胸部计算机断层扫描。在美国，这种方法的接受程度一直很慢且存在差异。我们估计了 2016 年至 2018 年期间国家和州一级的 LCS 率和增长率。
美国放射学院的肺癌筛查登记处用于捕获筛查事件。基于人群的调查、美国人口普查和癌症登记数据用于估计符合条件的成年人数量和肺癌死亡率（即负担）。使用肺癌筛查率（SR）在合格成年人和筛查率比与 95%置信区间（CI）来衡量按州和年份的变化。
在全国范围内，SR 在 2016 年（3.3%，95%CI=3.3%至 3.7%）和 2017 年（3.4%，95%CI=3.4%至 3.9%）之间保持稳定，2018 年增加到 5.0%（95%CI=5.0%至 5.7%）（2018 年与 2016 年 SR 比=1.52，95%CI=1.51 至 1.62）。在 2018 年，一些肺癌负担较高的南部州（例如密西西比州、西弗吉尼亚州和阿肯色州）在合格成年人中的 SR 相对较低（<4%），而一些肺癌负担较低的东北部州（例如马萨诸塞州、佛蒙特州和新罕布什尔州）的 SR 最高（12.8%-15.2%）。肯塔基州是个例外，该州的肺癌死亡率是全国最高的，同时也是 SR 最高的州之一（13.7%）。
全国范围内，只有不到 1/20 的合格成年人接受了 LCS，各州之间的接受程度差异很大。除了肯塔基州，各州的 LCS 率与肺癌负担不一致，肯塔基州一直支持实施 LCS 的综合努力。
