Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, China.
Centers for Disease Control and Prevention of Pudong New Area, Shanghai, China.
Chest. 2023 Jan;163(1):239-250. doi: 10.1016/j.chest.2022.08.2207. Epub 2022 Aug 23.
Overdiagnosis of lung cancer by low-dose CT (LDCT) screening has raised concerns globally. LDCT screening has been used widely in employee health examinations in China since 2011.
Has the increasing use of LDCT in low-risk populations in China led to lung cancer overdiagnosis?
A total of 34,152 incident cases of and 27,208 deaths resulting from lung cancer in a population of approximately 3 million were derived from the Cancer Surveillance of Shanghai between 2002 and 2017. Changes in stage-specific and histologic type-specific incidence and mortality and incidence rate ratio (IRR) relative to the base year 2002 or to the period 2002 through 2005 were calculated by sex and were used to evaluate potential overdiagnosisve of lung cancer.
In men, both age-adjusted incidence of and mortality as a result of lung cancer decreased significantly up to 2008 and thereafter remained stable; in women, the incidence increased rapidly from 2011 (annual percentage change, 11.98%; 95% CI, 9.57%-14.45%), whereas the mortality declined persistently. The upward trend of incidence mainly was observed in lung adenocarcinoma in both sexes, with a sharper increase from 2012 through 2017. In men, the incidence of early-stage cancer increased 6.9 per 100,000 (95% CI, 5.1-8.7 per 100,000) and was accompanied by 5.5 per 100,000 (95% CI, -9.2 to -1.7 per 100,000) decline in late-stagecancer from 2002 through 2017. In women, early-stage incidence rose 16.1 per 100,000 (95% CI, 14.0-18.3 per 100,000), but no significant decline in late-stage cancer was found (absolute difference, -0.6 per 100,000; 95% CI, -2.8 to 1.7 per 100,000). The IRR was highest in most recent period and increased most in young women, mainly for early-stage cancer or lung adenocarcinoma.
The results provide evidence at a population level for lung cancer overdiagnosis in Chinese women resulting from increasing LDCT screening in the low-risk populations. Criteria for LDCT screening and management of screening-detected nodules need to be addressed fully for expanded application of LDCT screening in China.
低剂量 CT（LDCT）筛查导致肺癌过度诊断的情况在全球范围内引起了关注。自 2011 年以来，LDCT 筛查在中国的员工健康检查中得到了广泛应用。
在中国，低危人群中 LDCT 的使用增加是否导致了肺癌的过度诊断？
本研究从 2002 年至 2017 年期间的上海癌症监测中获得了约 300 万人口中 34152 例肺癌发病和 27208 例肺癌死亡的病例。通过性别计算了特定阶段和特定组织学类型的发病率和死亡率的变化，以及与基准年 2002 年或 2002 年至 2005 年期间的发病率比值（IRR），以评估肺癌的潜在过度诊断。
在男性中，肺癌的发病率和死亡率在 2008 年之前显著下降，此后保持稳定；在女性中，发病率从 2011 年开始迅速上升（年变化率为 11.98%；95%CI 为 9.57%-14.45%），而死亡率持续下降。发病率的上升趋势主要见于男女肺腺癌，2012 年至 2017 年期间上升更为明显。在男性中，早期癌症的发病率增加了 6.9/100,000（95%CI 为 5.1-8.7/100,000），而晚期癌症的发病率则从 2002 年至 2017 年下降了 5.5/100,000（95%CI 为-9.2 至-1.7/100,000）。在女性中，早期癌症的发病率上升了 16.1/100,000（95%CI 为 14.0-18.3/100,000），但晚期癌症的发病率没有显著下降（绝对差异为-0.6/100,000；95%CI 为-2.8 至 1.7/100,000）。IRR 在最近的时间段最高，且在年轻女性中增加最多，主要是因为早期癌症或肺腺癌。
这些结果为中国女性由于 LDCT 在低危人群中的广泛应用而导致的肺癌过度诊断提供了人群水平的证据。需要充分考虑 LDCT 筛查的标准和筛查发现的结节的管理，以在中国进一步推广 LDCT 筛查。
