Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, and The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts (L.E.K.).
VA Ann Arbor Healthcare System and Center for Clinical Management Research, Ann Arbor, Michigan (P.B.).
Ann Intern Med. 2024 Sep;177(9):1222-1232. doi: 10.7326/M23-3250. Epub 2024 Aug 20.
The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.
To determine whether alternative criteria can identify these high-benefit people.
Model-based projections.
United States.
People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.
Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. "High-benefit" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.
The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; < 0.001) and specificity (86% vs. 84%; < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [ < 0.001]; Hispanic: 95% vs. 73% [ = 0.086]; Asian: 94% vs. 68% [ = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities.
The results were based on model projections.
These results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups.
U.S. Department of Veterans Affairs Lung Precision Oncology Program.
美国预防服务工作组（USPSTF）推荐的肺癌筛查（LCS）可能会排除一些高获益人群。
确定是否可以使用替代标准来识别这些高获益人群。
基于模型的预测。
美国。
使用快速简易树算法从 1997 年至 2014 年国家健康访谈调查（NHIS）中确定替代标准，并从 2014 年至 2018 年 NHIS 和 2022 年行为风险因素监测系统中进行比较，以确定 USPSTF 标准与替代标准的差异。
使用从筛查 CT（LYFS-CT）模型计算得出的筛查带来的生命年（LYFS-CT）来估计从 LCS 中获得的生命年。“高获益”被定义为通过每年三次筛查获得至少 16.2 天的平均寿命，如果通过筛查检测到肺癌，则可以获得较高的肺癌风险和显著的生命获益。
最终的替代标准是：1）每年至少吸烟 40 年且吸烟量达到任何程度的人，或 2）年龄在 60 至 80 岁之间且吸烟量达到 40 包年的人。USPSTF 和替代标准选择了类似数量的人进行 LCS。与 USPSTF 标准相比，替代标准对高获益人群的敏感性（91%对 78%；<0.001）和特异性（86%对 84%；<0.001）更高。对于少数族裔，替代标准的敏感性提高幅度大于 USPSTF 标准（黑人：83%对 56%[<0.001]；西班牙裔：95%对 73%[=0.086]；亚裔：94%对 68%[=0.171]），特异性相似。替代标准确定了 USPSTF 标准排除的高危、高获益人群（吸烟年限≥40 年但<20 包年且戒烟史>15 年），其中许多人是少数族裔。
结果基于模型预测。
这些结果表明，简单的替代 LCS 标准可以识别更多的高获益人群，特别是在某些种族和族裔群体中。
美国退伍军人事务部肺部精准肿瘤学计划。
