Clark Payton E, Taparra Kekoa, Miller Jacob A
Center for Immunotherapy and Precision Immuno-Oncology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Stanford University, Palo Alto, California.
Cancer Epidemiol Biomarkers Prev. 2024 Dec 2;33(12):1706-1716. doi: 10.1158/1055-9965.EPI-24-0576.
In the United States, Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC) disproportionately impacts Asian Americans (AA) and Native Hawaiians and other Pacific Islanders (NHPI) who have no access to screening. EBV-based screening trials in Asia have detected most cases at early stages. We sought to identify a US target population for NPC screening and hypothesized that once-lifetime screening could be cost-effective.
We obtained NPC incidence data from the Surveillance, Epidemiology, and End Results Asian and Pacific Islander datasets. We estimated the number needed to screen (NNS), mortality reduction, and resource utilization using a validated model and performance data from trials. Six evaluated strategies incorporated serology, nasopharyngeal swab PCR, and endoscopy or MRI.
Intermediate-incidence and high-incidence populations accounted for 10.7% of US person-years yet 42.7% of cases. Anti-BNLF2b screening with selective endoscopy was the preferred strategy. In high-incidence populations, the median NNS to detect one case was 1,992, with a median of 7.12 NPC deaths averted per 100,000 screened. Screening met the willingness-to-pay threshold in all five high-incidence populations (median incremental cost-effectiveness ratio/gross domestic product, 0.82) and among men in intermediate-incidence populations.
Nearly half of NPC in the United States arises among the 10% with AA or NHPI ethnicity. A suitable target population for US screening trials would be men and women aged 35 to 65 years of Chinese, Sāmoan, or Southeast Asian ethnicity, or men aged 35 to 60 years of Guamanian/Chamorro, Filipino, or Native Hawaiian ethnicity. Once-lifetime anti-BNLF2b screening could be cost-effective.
These data may aid the design of US screening trials. Targeted NPC screening might mitigate health disparities.
在美国，爱泼斯坦-巴尔病毒（EBV）相关的鼻咽癌（NPC）对无法进行筛查的亚裔美国人（AA）以及夏威夷原住民和其他太平洋岛民（NHPI）影响尤为严重。亚洲基于EBV的筛查试验在早期阶段发现了大多数病例。我们试图确定美国鼻咽癌筛查的目标人群，并假设一生一次的筛查可能具有成本效益。
我们从监测、流行病学和最终结果亚洲及太平洋岛民数据集中获取鼻咽癌发病率数据。我们使用经过验证的模型和试验性能数据估计了需要筛查的人数（NNS）、死亡率降低情况以及资源利用情况。六种评估策略包括血清学、鼻咽拭子PCR以及内窥镜检查或MRI。
中等发病率和高发病率人群占美国总人年数的10.7%，但却占病例数的42.7%。采用选择性内窥镜检查的抗BNLF2b筛查是首选策略。在高发病率人群中，检测出一例病例的NNS中位数为1992，每10万人筛查可避免的NPC死亡中位数为7.12例。筛查在所有五个高发病率人群（中位数增量成本效益比/国内生产总值，0.82）以及中等发病率人群中的男性中均达到了支付意愿阈值。
美国近一半的鼻咽癌病例出现在10%的亚裔或夏威夷原住民及其他太平洋岛民种族人群中。美国筛查试验的合适目标人群应为35至65岁的华裔、萨摩亚裔或东南亚裔男性和女性，或35至60岁的关岛/查莫罗裔、菲律宾裔或夏威夷原住民男性。一生一次的抗BNLF2b筛查可能具有成本效益。
这些数据可能有助于美国筛查试验的设计。有针对性的鼻咽癌筛查可能会减少健康差距。
