Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
J Thorac Oncol. 2022 Jan;17(1):160-166. doi: 10.1016/j.jtho.2021.09.011. Epub 2021 Oct 12.
In 2021, the U.S. Preventive Services Task Force (USPSTF) revised its lung cancer screening recommendations expanding its eligibility. As more smokers become eligible, cessation interventions at the point of screening could enhance the benefits. Here, we evaluate the effects of joint screening and cessation interventions under the new recommendations.
A validated lung cancer natural history model was used to estimate lifetime number of low-dose computed tomography screens, percentage ever screened, lung cancer deaths, lung cancer deaths averted, and life-years gained for the 1960 U.S. birth cohort aged 45 to 90 years (4.5 million individuals). Screening occurred according to the USPSTF 2013 and 2021 recommendations with varying uptake (0%, 30%, 100%), with or without a cessation intervention at the point of screening with varying effectiveness (15%, 100%).
Screening 30% of the eligible population according to the 2021 criteria with no cessation intervention (USPSTF 2021, 30% uptake, without cessation intervention) was estimated to result in 6845 lung cancer deaths averted and 103,725 life-years gained. These represent 28% and 34% increases, respectively, relative to screening according to the 2013 guidelines (USPSTF 2013, 30% uptake, without cessation intervention). Adding a cessation intervention at the time of the first screen with 15% effectiveness (USPSTF 2021, 30% uptake, with cessation intervention with 15% effectiveness) was estimated to result in 2422 additional lung cancer deaths averted (9267 total, ∼73% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 322,785 life-years gained (∼318% increase). Screening 100% of the eligible according to the 2021 guidelines with no cessation intervention (USPSTF 2021, 100% uptake, without cessation intervention) was estimated to result in 23,444 lung cancer deaths averted (∼337% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 354,330 life-years gained (∼359% increase). Adding a cessation intervention with 15% effectiveness (USPSTF 2021, 100% uptake, with cessation intervention with 15% effectiveness) would result in 31,998 lung cancer deaths averted (∼497% increase versus USPSTF 2013, 30% uptake, without cessation intervention) and 1,086,840 life-years gained (∼1309% increase).
Joint screening and cessation interventions would result in considerable lung cancer deaths averted and life-years gained. Adding a one-time cessation intervention of modest effectiveness (15%) results in comparable life-years gained as increasing screening uptake from 30% to 100% because while cessation decreases mortality from many causes, screening only reduces lung cancer mortality. This simulation indicates that incorporating cessation programs into screening practice should be a priority as it can maximize overall benefits.
2021 年，美国预防服务工作组（USPSTF）修订了肺癌筛查建议，扩大了其资格范围。随着更多吸烟者符合条件，在筛查时进行戒烟干预可以提高其收益。在此，我们评估了新建议下联合筛查和戒烟干预的效果。
使用经过验证的肺癌自然史模型来估计每位符合条件的 45 至 90 岁（450 万人）的美国 1960 年出生队列的一生中接受低剂量计算机断层扫描的次数、接受筛查的百分比、肺癌死亡人数、肺癌死亡人数的减少以及获得的寿命年数。根据 USPSTF 2013 年和 2021 年的建议进行筛查，筛查的接受率（0%、30%、100%）不同，是否有一个在筛查时具有不同效果（15%、100%）的戒烟干预。
根据 2021 年标准筛查 30%的合格人群（USPSTF 2021，30%的接受率，无戒烟干预）预计可避免 6845 例肺癌死亡和 103725 个寿命年。这分别代表相对于根据 2013 年指南进行筛查（USPSTF 2013，30%的接受率，无戒烟干预），增加了 28%和 34%。如果在第一次筛查时添加一个效果为 15%的戒烟干预（USPSTF 2021，30%的接受率，带有 15%效果的戒烟干预），预计将额外避免 2422 例肺癌死亡（总共 2422 例，与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 73%），并获得 322785 个寿命年（与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 318%）。根据 2021 年的指南，对所有符合条件的人进行筛查（USPSTF 2021，100%的接受率，无戒烟干预），预计可避免 23444 例肺癌死亡（与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 337%），并获得 354330 个寿命年（与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 359%）。如果添加一个效果为 15%的戒烟干预（USPSTF 2021，100%的接受率，带有 15%效果的戒烟干预），则可避免 31998 例肺癌死亡（与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 497%），并获得 1086840 个寿命年（与 USPSTF 2013，30%的接受率，无戒烟干预相比，增加了约 1309%）。
联合筛查和戒烟干预将显著减少肺癌死亡人数和获得的寿命年数。添加一个效果适度（15%）的一次性戒烟干预可以获得与将筛查接受率从 30%增加到 100%相同的寿命年数，因为虽然戒烟可以降低多种原因导致的死亡率，但筛查仅能降低肺癌死亡率。这项模拟表明，将戒烟计划纳入筛查实践应成为优先事项，因为这可以最大限度地提高整体收益。
