Division of Cancer Prevention, National Cancer Institute, Bethesda, MD.
Department of Family Medicine, Mayo Clinic, Rochester, MN.
Chest. 2021 Jul;160(1):341-350. doi: 10.1016/j.chest.2021.01.070. Epub 2021 Feb 3.
Criteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations.
What are the eligibility rates for low-dose CT scan screening according to sex and race or ethnicity and how do these rates relate to corresponding lung cancer incidence rates?
This was a cross-sectional study using data from the 2015 National Health Interview Survey adult and cancer control supplement files. In addition to eligibility rates, the ratio of the eligibility rate to the lung cancer incidence rate in a given population group (eligibility to incidence [E-I] ratio) also was determined. Guidelines assessed were: Centers for Medicare and Medicaid Services, National Comprehensive Cancer Network, and US Preventive Services Task Force current or with expansion of age and smoking or quit thresholds. We also assessed a risk model (PLCO risk model).
Total numbers eligible based on current guidelines ranged from 8.3 to 13.3 million, representing 8.3% to 13.4% of the US population 50 to 80 years of age, and up to 17.5 million with expanded criteria. Overall eligibility rates on average were about 10 percentage points higher for men than women. For both men and women, and both overall and among ever smokers, non-Hispanic Whites had the highest eligibility rates across all guidelines, followed generally by non-Hispanic Blacks, and then Asians and Hispanics. Among both men and women, non-Hispanic Whites had the highest E-I ratios across all guidelines; non-Hispanic Black men had higher lung cancer incidence, but 30% to 50% lower E-I ratios, than non-Hispanic White men.
Screening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.
低剂量 CT 扫描肺癌筛查的标准因指南而异。了解不同人群的合格人群，可以为政策和项目决策提供依据，特别是对受影响比例较大的人群。
根据性别、种族或民族，低剂量 CT 扫描筛查的合格率是多少，这些比率与相应的肺癌发病率之间有何关系？
这是一项使用 2015 年国家健康访谈调查成人和癌症控制补充文件数据的横断面研究。除了合格率外，还确定了给定人群中合格率与肺癌发病率的比值（合格率与发病率之比[E-I 比]）。评估的指南包括：医疗保险和医疗补助服务中心、国家综合癌症网络和美国预防服务工作组目前或扩大年龄和吸烟或戒烟阈值的指南。我们还评估了一个风险模型（PLCO 风险模型）。
根据现行指南，总共有 830 万至 1330 万人符合条件，占 50 至 80 岁美国人口的 8.3%至 13.4%，扩大标准后可达 1750 万人。总体而言，男性的合格率平均比女性高 10 个百分点。对于男性和女性，以及所有吸烟者和非吸烟者，所有指南中，非西班牙裔白人的合格率最高，其次是非西班牙裔黑人，然后是亚裔和西班牙裔。在所有指南中，男性和女性的非西班牙裔白人的 E-I 比值最高；非西班牙裔黑人男性的肺癌发病率较高，但 E-I 比值比非西班牙裔白人男性低 30%至 50%。
筛查的合格率因指南而异，E-I 比值也存在差异，包括非西班牙裔黑人男性，尽管他们的肺癌负担较重。在风险评估标准中考虑吸烟持续时间可能会解决当前的差异。
