Kim Yeon Wook, Joo Dong-Hyun, Kim So Yeon, Park Young Sik, Jang Sowon, Lee Jong Hyuk, Silvestri Gerard A, Heuvelmans Marjolein A, Kim Jihang, Hwang Hyeontaek, Lee Choon-Taek
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Internal Medicine, Seoul National University College of Medicine.
JAMA Netw Open. 2025 Jan 2;8(1):e2454057. doi: 10.1001/jamanetworkopen.2024.54057.
Lung cancer in individuals who have never smoked (INS) is a growing global concern, with a rapidly increasing incidence and proportion among all lung cancer cases. Particularly in East Asia, opportunistic lung cancer screening (LCS) programs targeting INS have gained popularity. However, the sex-specific outcomes and drawbacks of screening INS remain unexplored, with data predominantly focused on women.
To compare LCS outcomes between Asian women and men with no smoking history.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was conducted at health checkup centers in South Korea from 2009 to 2021. Participants included individuals aged 50 to 80 years with no smoking history who underwent low-dose computed tomography (LDCT) screening. Data were retrospectively analyzed from November 2023 to June 2024.
Opportunistic LDCT screening for lung cancer.
Participants were followed up until December 2022 for the outcome of death. Lung cancer diagnosis, diagnostic characteristics, clinical course, and lung cancer-specific deaths (LCSD) were compared between women and men.
A total of 21 062 participants (16 133 [76.6%] women and 4929 [23.4%] men) with a mean (SD) age of 59.8 (7.2) years were included. From baseline screening, 176 participants (139 women [0.9%] and 37 men [0.8%]) were diagnosed with lung cancer (screen-detected); 131 of 139 women (94.3%) and 33 of 37 men (89.2%) were diagnosed with stage 0 to I disease, with 133 of 139 women (95.7%) and 36 of 37 men (97.3%) having adenocarcinoma. There were no significant sex-based differences in stage or histologic type distribution. Among the 21 062 screened individuals, LCSD was reported in 8 women and 3 men during a mean (SD) follow-up of 83.8 (41.7) months. Multivariable analyses found no significant association between sex and cumulative hazards of lung cancer diagnosis (adjusted hazard ratio [aHR], 0.90 [95% CI, 0.64-1.26] for men vs women) or LCSD (aHR, 1.06 [95% CI, 0.28-4.00] for men vs women). The estimated 5-year lung cancer-specific survival rate was 97.7% for women and 100% for men with screen-detected lung cancer, showing no significant sex differences.
In this cohort study of Asian individuals with no smoking history who underwent LDCT screening, no significant sex-based differences were detected in lung cancer diagnosis, stage distribution, or LCSD. These findings suggest that men and women who have never smoked would experience similar risks of overdiagnosis with little to no benefit when exposed to indiscriminate screening.
从不吸烟个体（INS）中的肺癌是一个日益受到全球关注的问题，在所有肺癌病例中的发病率和比例都在迅速上升。特别是在东亚，针对INS的机会性肺癌筛查（LCS）项目越来越受欢迎。然而，筛查INS的性别特异性结果和缺点仍未得到探索，数据主要集中在女性身上。
比较无吸烟史的亚洲女性和男性的LCS结果。
设计、地点和参与者：这项多中心队列研究于2009年至2021年在韩国的健康检查中心进行。参与者包括年龄在50至80岁、无吸烟史且接受低剂量计算机断层扫描（LDCT）筛查的个体。数据于2023年11月至2024年6月进行回顾性分析。
机会性LDCT肺癌筛查。
对参与者进行随访直至2022年12月，以获取死亡结局。比较了女性和男性之间的肺癌诊断、诊断特征、临床病程和肺癌特异性死亡（LCSD）情况。
共纳入21062名参与者（16133名[76.6%]女性和4929名[23.4%]男性），平均（标准差）年龄为59.8（7.2）岁。从基线筛查开始，176名参与者（139名女性[0.9%]和37名男性[0.8%]）被诊断为肺癌（筛查发现）；139名女性中的131名（94.3%）和37名男性中的33名（89.2%）被诊断为0至I期疾病，139名女性中的133名（95.7%）和37名男性中的36名（97.3%）患有腺癌。在分期或组织学类型分布方面，未发现基于性别的显著差异。在21062名接受筛查的个体中，在平均（标准差）83.8（41.7）个月的随访期间，有8名女性和3名男性报告了LCSD。多变量分析发现，性别与肺癌诊断的累积风险（男性与女性的调整后风险比[aHR]为0.90[95%CI，0.64 - 1.26]）或LCSD（男性与女性的aHR为1.06[95%CI，0.28 - 4.00]）之间无显著关联。筛查发现肺癌的女性和男性的估计5年肺癌特异性生存率分别为97.7%和100%，未显示出显著的性别差异。
在这项对接受LDCT筛查的无吸烟史亚洲个体的队列研究中，在肺癌诊断、分期分布或LCSD方面未检测到基于性别的显著差异。这些发现表明，从不吸烟的男性和女性在接受不加区分的筛查时，会面临相似的过度诊断风险，且几乎没有益处。
