Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.
Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha.
JAMA Netw Open. 2022 Nov 1;5(11):e2243163. doi: 10.1001/jamanetworkopen.2022.43163.
Currently, computed tomography (CT) is used for lung cancer screening (LCS) among populations with various levels of compliance to the eligibility criteria from the US Preventive Services Task Force (USPSTF) recommendations and may represent suboptimal allocation of health care resources.
To evaluate the appropriateness of CT LCS according to the USPSTF eligibility criteria.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants included individuals who responded to the LCS module administered in 20 states and had valid answers to questions regarding screening and smoking history. Data were analyzed between October 2021 and August 2022.
Screening eligibility groups were categorized according to the USPSTF 2013 recommendations, and subgroups of individuals who underwent LCS were analyzed.
Main outcomes included LCS among the screening-eligible population and the proportions of the screened populations according to compliance categories established from the USPSTF 2013 and 2021 recommendations. In addition, the association between respondents' characteristics and LCS was evaluated for the subgroup who were screened despite not meeting any of the 3 USPSTF screening criteria: age, pack-year, and years since quitting smoking.
A total of 96 097 respondents were identified for the full study cohort, and 2 subgroups were constructed: (1) 3374 respondents who reported having a CT or computerized axial tomography to check for lung cancer and (2) 33 809 respondents who did not meet any screening eligibility criteria. The proportion of participants who were under 50 years old was 53.1%; between 50 and 54, 9.1%; between 55 and 79, 33.8%; and over 80, 4.0%. A total of 51 536 (50.9%) of the participants were female. According to the USPSTF 2013 recommendation, 807 (12.8%) of the screening-eligible population underwent LCS. Among those who were screened, only 807 (20.9%) met all 3 screening eligibility criteria, whereas 538 (20.1%) failed to meet any criteria. Among respondents in subgroup 2, being of older age and having a history of stroke, chronic obstructive pulmonary disease, kidney disease, or diabetes were associated with higher likelihood of LCS.
In this cross-sectional study of the BRFSS 2019 survey, the low uptake rate among screening-eligible patients undermined the goal of LCS of early detection. Suboptimal screening patterns could increase health system costs and add financial stress, psychological burden, and physical harms to low-risk patients, while failing to provide high-quality preventive services to individuals at high risk of lung cancer.
目前，计算机断层扫描（CT）用于具有不同程度符合美国预防服务工作组（USPSTF）建议的肺癌筛查（LCS）资格标准的人群，并且可能代表医疗保健资源的分配不合理。
根据 USPSTF 的资格标准，评估 CT LCS 的适宜性。
设计、地点和参与者：这项横断面研究使用了 2019 年行为风险因素监测系统（BRFSS）调查。参与者包括对在 20 个州进行的 LCS 模块做出回应且对筛查和吸烟史有有效答案的个人。数据于 2021 年 10 月至 2022 年 8 月之间进行分析。
根据 USPSTF 2013 年的建议，将筛查合格人群分为不同组别，同时分析了接受 LCS 的亚组。
主要结果包括符合筛查条件的人群中的 LCS 情况，以及根据 USPSTF 2013 年和 2021 年建议建立的合规类别，根据筛选结果对筛选人群的比例。此外，还评估了受访者特征与尽管不符合 USPSTF 3 项筛查标准中的任何一项（年龄、吸烟年数和戒烟年数）但仍接受 LCS 的亚组之间的关系。
共有 96097 名受访者被确定为整个研究队列的成员，并构建了 2 个亚组：（1）3374 名报告曾进行 CT 或计算机轴向断层扫描以检查肺癌的患者；（2）33809 名不符合任何筛查资格标准的患者。年龄在 50 岁以下的参与者比例为 53.1%；在 50 至 54 岁之间，为 9.1%；在 55 至 79 岁之间，为 33.8%；在 80 岁以上，为 4.0%。共有 51536 名（50.9%）参与者为女性。根据 USPSTF 2013 年的建议，有 807 名（12.8%）符合筛查条件的人群接受了 LCS。在接受筛查的人群中，只有 807 名（20.9%）符合所有 3 项筛查资格标准，而 538 名（20.1%）不符合任何标准。在亚组 2 的受访者中，年龄较大且有中风、慢性阻塞性肺疾病、肾病或糖尿病病史的人更有可能进行 LCS。
在这项对 2019 年 BRFSS 调查的横断面研究中，符合筛查条件的患者的低接受率破坏了早期发现肺癌的 LCS 目标。不理想的筛查模式可能会增加医疗系统的成本，并给低风险患者带来经济压力、心理负担和身体伤害，同时未能为高风险肺癌患者提供高质量的预防服务。
