Laisaar Tanel, Kallavus Kadi, Poola Anneli, Räppo Mari, Taur Merily, Makke Vahur, Frik Marianna, Ilves Pilvi, Laisaar Kaja-Triin
Lung Clinic, Tartu University Hospital, Tartu, Estonia; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Lung Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia; Lung Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
Cancer Treat Res Commun. 2025;43:100889. doi: 10.1016/j.ctarc.2025.100889. Epub 2025 Feb 26.
Lung cancer screening (LCS) is recommended by international societies, yet it is still debated how to efficiently enrol participants. The aim of this study was to evaluate systematic enrolment of patients through family physicians in a regional LCS pilot study in Estonia.
This study was conducted in one county (with approximately 10 % of the country's population), where all family physicians were approached. In each participating practice, all 55- to 74-year-old individuals were identified and evaluated by the family physician or nurse. Two LCS inclusion criteria were used in parallel - individuals with elevated lung cancer (LC) risk, according to either smoking status (≥20 pack-years; quit <15 years ago) and/or a PLCO risk score (>1.5 %/6 years), underwent low-dose computed tomography (LDCT). The scans were evaluated and participants managed according to LungRADS 1.1 protocol.
Seventy-four participating family physician practices had 26 759 patients in the target age group. During the inclusion period 24 413 individuals were evaluated, of whom 17 215 were excluded. Of the remaining 7198 individuals, 3708 had higher LC risk and were referred for LDCT. Of the 3444 individuals who underwent LDCT, 30 were diagnosed with LC. Considering the total LCS target age group, an estimated participation rate of 79.3 % (95 %CI 78.1 %-80.5 %) was achieved.
Population-based systematic enrolment of participants for LCS by family physicians and nurses ensured very high uptake in the target group, providing a valuable reference for planning LCS programs in countries with family physicians on board.
国际社会推荐进行肺癌筛查（LCS），但如何有效招募参与者仍存在争议。本研究的目的是在爱沙尼亚的一项区域性LCS试点研究中，评估通过家庭医生对患者进行系统招募的情况。
本研究在一个县（约占该国人口的10%）进行，所有家庭医生均参与其中。在每个参与的诊所中，家庭医生或护士对所有55至74岁的个体进行识别和评估。同时使用了两个LCS纳入标准——根据吸烟状况（≥20包年；戒烟时间<15年前）和/或PLCO风险评分（>1.5%/6年），确定肺癌（LC）风险升高的个体，接受低剂量计算机断层扫描（LDCT）。根据LungRADS 1.1协议对扫描结果进行评估并对参与者进行管理。
74个参与的家庭医生诊所在目标年龄组中有26759名患者。在纳入期间，对24413名个体进行了评估，其中17215名被排除。在其余的7198名个体中，3708名有较高的LC风险，并被转诊进行LDCT检查。在接受LDCT检查的3444名个体中，有30名被诊断为LC。考虑到整个LCS目标年龄组，估计参与率达到了79.3%（95%CI 78.1%-80.5%）。
由家庭医生和护士对参与者进行基于人群的系统招募，确保了目标群体的高参与率，为有家庭医生参与的国家规划LCS项目提供了有价值的参考。
