Országos Korányi Pulmonológiai Intézet, National Korányi Institute for Pulmonology, Budapest, Hungary.
Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
J Thorac Oncol. 2022 Jan;17(1):56-66. doi: 10.1016/j.jtho.2021.07.031. Epub 2021 Aug 27.
Screening with low-dose computed tomography of high-risk individuals with a smoking history reduces lung cancer mortality. Current screening guidelines and eligibility criteria can miss more than 50% of lung cancers, and in some geographic areas, such as East Asia, a large proportion of the missed lung cancers are in never-smokers. Although randomized trials revealed the benefits of screening for people who smoke, these trials generally excluded never-smokers. Thus, the feasibility and effectiveness of lung cancer screening of individuals who never smoked are uncertain. Several known and suspected risk factors for lung cancers in never-smokers such as exposure to secondhand smoke, occupational carcinogens, radon, air pollution, and pulmonary diseases, such as chronic obstructive pulmonary disease and interstitial lung diseases, and intrinsic factors, such as age, are well noted. In this regard, knowledge of risk factors may make possible quantification and prediction of lung cancer risk in never smokers. It is worth considering if and how never smokers could be included in population-based screening programs. As the implementation of these programs is challenging in many countries owing to multiple factors and the epidemiologic differences by global regions, these issues will need to be evaluated in each country taking into account various factors, including accuracy of risk assessment and cost-effectiveness of screening in never smokers. This report aims to outline current knowledge on risk factors for lung cancer in never smokers to propose research strategies for this topic and initiate a broader discussion on lung cancer screening of never smokers. Similar considerations can be made in current and ex-smokers, which do not fulfill the current screening inclusion criteria, but otherwise are at increased risk. Although screening of never smokers may in the future be effectively conducted, current evidence to support widespread implementation of this practice is lacking.
对有吸烟史的高危人群进行低剂量计算机断层扫描筛查可降低肺癌死亡率。目前的筛查指南和入选标准可能会遗漏超过 50%的肺癌病例，而且在东亚等一些地区，大量被遗漏的肺癌病例发生在从不吸烟者中。虽然随机试验显示了对吸烟者进行筛查的益处，但这些试验通常排除了从不吸烟者。因此，从未吸烟者中进行肺癌筛查的可行性和有效性尚不确定。一些已知的和疑似的从不吸烟者肺癌的危险因素，如二手烟暴露、职业致癌物、氡气、空气污染、慢性阻塞性肺疾病和间质性肺疾病等肺部疾病，以及年龄等内在因素，都得到了很好的认识。在这方面，对危险因素的认识可能使从未吸烟者的肺癌风险能够进行量化和预测。值得考虑的是，是否以及如何将从不吸烟者纳入基于人群的筛查计划中。由于多种因素以及全球各地区的流行病学差异，这些计划在许多国家的实施都具有挑战性，因此需要在考虑到包括从不吸烟者的风险评估准确性和筛查的成本效益等各种因素的情况下，在每个国家进行评估。本报告旨在概述从不吸烟者肺癌风险的现有知识，为这一主题提出研究策略，并就从不吸烟者的肺癌筛查展开更广泛的讨论。目前和曾经吸烟但不符合当前筛查纳入标准的人群也存在更高的风险，也可以考虑类似的考虑因素。虽然未来可能会有效地对从不吸烟者进行筛查，但目前缺乏支持广泛实施这一做法的证据。
