Miranda-Filho Adalberto, Charvat Hadrien, Bray Freddie, Migowski Arn, Cheung Li C, Vaccarella Salvatore, Johansson Mattias, Carvalho Andre L, Robbins Hilary A
International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372 CEDEX 08, France.
Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), Brazil.
EClinicalMedicine. 2021 Nov 1;42:101176. doi: 10.1016/j.eclinm.2021.101176. eCollection 2021 Dec.
Country-specific evidence is needed to guide decisions regarding whether and how to implement lung cancer screening in different settings. For this study, we estimated the potential numbers of individuals screened and lung cancer deaths prevented in Brazil after applying different strategies to define screening eligibility.
We applied the Lung Cancer Death Risk Assessment Tool (LCDRAT) to survey data on current and former smokers (ever-smokers) in 15 Brazilian state capital cities that comprise 18% of the Brazilian population. We evaluated three strategies to define eligibility for screening: (1) pack-years and cessation time (≥30 pack-years and <15 years since cessation); (2) the LCDRAT risk model with a fixed risk threshold; and (3) LCDRAT with age-specific risk thresholds.
Among 2.3 million Brazilian ever-smokers aged 55-79 years, 21,459 (95%CI 20,532-22,387) lung cancer deaths were predicted over 5 years without screening. Applying the fixed risk-based eligibility definition would prevent more lung cancer deaths than the pack-years definition [2,939 (95%CI 2751-3127) vs. 2,500 (95%CI 2318-2681) lung cancer deaths], and with higher screening efficiency [NNS=177 (95%CI 170-183) vs. 205 (95%CI 194-216)], but would tend to screen older individuals [mean age 67.8 (95%CI 67.5-68.2) vs. 63.4 (95%CI 63.0-63.9) years]. Applying age-specific risk thresholds would allow younger ever-smokers to be screened, although these individuals would be at lower risk. The age-specific thresholds strategy would avert three-fifths (60.1%) of preventable lung cancer deaths [ = 2629 (95%CI 2448-2810)] by screening 21.9% of ever-smokers.
The definition of eligibility impacts the efficiency of lung cancer screening and the mean age of the eligible population. As implementation of lung screening proceeds in different countries, our analytical framework can be used to guide similar analyses in other contexts. Due to limitations of our models, more research would be needed.
需要特定国家的证据来指导关于在不同环境中是否以及如何实施肺癌筛查的决策。在本研究中，我们估计了在巴西应用不同策略定义筛查资格后，接受筛查的潜在人数以及预防的肺癌死亡人数。
我们将肺癌死亡风险评估工具（LCDRAT）应用于巴西15个州首府城市中当前和曾经吸烟者（既往吸烟者）的调查数据，这些城市占巴西人口的18%。我们评估了三种定义筛查资格的策略：（1）吸烟包年数和戒烟时间（≥30包年且戒烟时间<15年）；（2）具有固定风险阈值的LCDRAT风险模型；（3）具有年龄特异性风险阈值的LCDRAT。
在230万年龄在55 - 79岁的巴西既往吸烟者中，预计在未进行筛查的情况下，5年内将有21,459例（95%CI 20,532 - 22,387）肺癌死亡。应用基于风险的固定资格定义比吸烟包年数定义能预防更多的肺癌死亡[2,939例（95%CI 2751 - 3127）对2,500例（95%CI 2318 - 2681）肺癌死亡]，且筛查效率更高[NNS = 177（95%CI 170 - 183）对205（95%CI 194 - 216）]，但倾向于筛查年龄较大的个体[平均年龄67.8岁（95%CI 67.5 - 68.2）对63.4岁（95%CI 63.0 - 63.9）]。应用年龄特异性风险阈值将允许年龄较小的既往吸烟者接受筛查，尽管这些个体的风险较低。年龄特异性阈值策略将通过筛查21.9%的既往吸烟者避免五分之三（60.1%）可预防的肺癌死亡[ = 2629例（95%CI 2448 - 2810）]。
资格定义会影响肺癌筛查的效率和符合资格人群的平均年龄。随着不同国家肺癌筛查的实施，我们的分析框架可用于指导其他背景下的类似分析。由于我们模型的局限性，还需要更多研究。
