de Nijs Koen, Ten Haaf Kevin, van der Aalst Carlijn, de Koning Harry J
Department of Public Health, Erasmus MC - University Medical Center Rotterdam, 3015 CE Rotterdam, The Netherlands.
EClinicalMedicine. 2024 Apr 8;71:102570. doi: 10.1016/j.eclinm.2024.102570. eCollection 2024 May.
The NELSON trial demonstrated a 24% intention-to-screen reduction in lung cancer mortality from regular screening with low-dose computed tomography. Implementation efforts in Europe are ongoing, but still await country-specific and NELSON-adapted estimates of the benefits and harms of screening.
We use the MISCAN-Lung microsimulation model, calibrated to individual-level outcomes from the NELSON trial, to estimate the effectiveness under 100% compliance of biennial lung cancer screening with concomitant smoking cessation support for Dutch cohorts 1942-1961. The model simulates smoking behaviour, lung cancer incidence and the effects of screening and smoking cessation on lung- and other-cause mortality.
We find biennial screening with eligibility criteria equal to those of the 4-IN-THE-LUNG-RUN implementation trial to reduce lung cancer mortality by 16.9% among the eligible population, equivalent to 1076 LC deaths prevented per year in the next two decades. Eligible individuals constitute 21.5% of the cohorts studied, and stand to face 61% of the projected lung cancer mortality burden in the absence of screening. 10.3 life-years are gained per prevented LC death, for 14.9 screens per life year gained. Concomitant smoking cessation interventions may increase the expected gains in life years from screening by up to 20%.
Policy makers should imminently consider the implementation of lung cancer screening in Europe, paired with effective smoking cessation interventions. Smoking cessation interventions on their own are not estimated to yield a gain in remaining life expectancy of the magnitude offered by even a single CT screen.
European UnionHorizon 2020 grant 848294: 4-IN-THE-LUNG-RUN.
NELSON试验表明，通过低剂量计算机断层扫描进行定期筛查可使肺癌死亡率降低24%（意向性筛查分析）。欧洲正在进行相关实施工作，但仍需针对各国情况并根据NELSON试验结果对筛查的益处和危害进行具体评估。
我们使用MISCAN-Lung微观模拟模型，该模型根据NELSON试验的个体水平结果进行校准，以估计1942 - 1961年荷兰队列每两年进行一次肺癌筛查并同时提供戒烟支持且100%依从情况下的有效性。该模型模拟吸烟行为、肺癌发病率以及筛查和戒烟对肺癌及其他原因死亡率的影响。
我们发现，筛查标准与“4-IN-THE-LUNG-RUN”实施试验相同的两年一次筛查可使符合条件人群的肺癌死亡率降低16.9%，相当于在未来二十年每年预防1076例肺癌死亡。符合条件的个体占所研究队列的21.5%，在未进行筛查的情况下，预计将面临61%的肺癌死亡负担。每预防一例肺癌死亡可获得10.3个生命年，每获得一个生命年需要进行14.9次筛查。同时进行戒烟干预可能会使筛查带来的预期生命年收益增加20%。
政策制定者应立即考虑在欧洲实施肺癌筛查，并配套有效的戒烟干预措施。仅靠戒烟干预预计无法带来与单次CT筛查相当的剩余预期寿命收益。
欧盟“地平线2020”资助项目848294：“4-IN-THE-LUNG-RUN”。
