Smeltzer Matthew P, Liao Wei, Goss Jordan, Qureshi Talat, Johnson Sara, Harris Amanda, Dortch Kourtney, Fehnel Carrie, Ely Sora, Ray Meredith, Osarogiagbon Raymond U
Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee.
Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
JAMA Netw Open. 2025 Jun 2;8(6):e2517149. doi: 10.1001/jamanetworkopen.2025.17149.
Many individuals with lung cancer are not eligible for lung cancer screening (LCS). Race-based and sex-based differences in smoking patterns reduce the effectiveness of LCS criteria.
To assess the value of expanding LCS criteria beyond US Preventive Services Task Force (USPSTF) 2021 guidelines by relaxing cigarette smoking exposure criteria.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included individuals enrolled in an incidental pulmonary nodule (IPN) program with non-screening-detected, potentially malignant pulmonary nodules, or enrolled in a LCS program from 2015 to 2023. Participants were treated in a community-based health care system serving more than 125 counties in Mississippi, Tennessee, Arkansas, Kentucky, Missouri, and Alabama. Data were examined from October 1, 2024, to May 29, 2025.
LCS eligibility criteria included USPSTF 2021, Potter criteria (20-year smoking history), and American Cancer Society criteria ([ACS] 20 pack-years, no quit duration), and expansions to 10 years or 10 pack-years.
The main outcomes were proportions of individuals eligible for LCS and diagnosis of lung cancer. Characteristics between groups were compared using the χ2 test for categorical variables and the Wilcoxon-Mann-Whitney test for continuous variables.
In this study, 43 521 individuals were evaluated, including 13 770 (32%) from LCS and 29 751 (68%) from IPN programs. Of the 29751 individuals in IPN programs, 3840 (13%) were eligible for LCS by USPSTF 2021 criteria, 4905 (16%) by IPN-Potter criteria, 5263 (18%) by IPN-ACS criteria, and 6307 (21%) by IPN-Potter-ACS criteria. There were 1103 additional individuals eligible by IPN-Potter criteria (606 female [55%] and 382 Black [35%]), 1423 by IPN-ACS criteria (628 female [44%]; 237 Black [17%]), and 2467 by IPN-Potter-ACS criteria (1200 female [49%]; 615 Black [25%]). There were significant differences in the number of additional eligible individuals who were female (55% vs 48%; P < .001) and Black (35% vs 22%; P < .001) between the IPN-Potter and USPSTF 2021 criteria. Lung cancer was diagnosed in 504 of 13 770 of LCS enrollees (4%) and 1714 of 29 751 of IPN enrollees (6%), including 872 of 4905 (18%) eligible by IPN-Potter criteria, 955 of 5263 (18%) by IPN-ACS criteria, and 1051 of 6307 (17%) by IPN-Potter-ACS criteria. The additional eligible individuals with lung cancer in IPN programs who were female included 70 of 128 (55%) by IPN-Potter criteria, 89 of 208 (43%) by IPN-ACS criteria, and 143 of 304 (47%) by IPN-Potter-ACS criteria, with statistically significant differences between the IPN-Potter criteria and USPSTF 2021 criteria (55% vs 48%; P < .001). The additional eligible individuals who were Black included 50 of 128 (39%) by IPN-Potter criteria, 32 of 208 (15%) by IPN-ACS criteria, and 73 of 304 (24%) by IPN-Potter-ACS criteria, with statistically significant differences between IPN-Potter criteria and IPN-USPSTF 2021 criteria (39% vs 22%; P < .001). When LCS criteria were expanded to individuals older than 50 years who had smoked for 10 years or 10 pack-years, 7993 of 29 751 individuals (27%) from IPN programs would have been eligible. Among these, 1251 of 7993 (16%) were diagnosed with lung cancer.
In this cohort study, changing smoking criteria from 20 pack-years to a 20-year smoking history was associated with improved access to LCS while maintaining diagnostic efficiency. Expansion to individuals with a 10-year or 10 pack-years smoking history should be explored.
许多肺癌患者不符合肺癌筛查（LCS）的条件。基于种族和性别的吸烟模式差异降低了LCS标准的有效性。
通过放宽吸烟暴露标准，评估在美国预防服务工作组（USPSTF）2021年指南之外扩大LCS标准的价值。
设计、设置和参与者：这项队列研究纳入了参加偶发性肺结节（IPN）项目的个体，这些个体有非筛查发现的、潜在恶性的肺结节，或在2015年至2023年期间参加LCS项目。参与者在一个服务于密西西比州、田纳西州、阿肯色州、肯塔基州、密苏里州和阿拉巴马州125多个县的社区医疗保健系统中接受治疗。数据于2024年10月1日至2025年5月29日进行检查。
LCS资格标准包括USPSTF 2021年标准、波特标准（20年吸烟史）和美国癌症协会标准（[ACS]20包年，无戒烟时长），以及扩展到10年或10包年。
主要结局是符合LCS条件的个体比例和肺癌诊断情况。使用卡方检验比较分类变量组间特征，使用威尔科克森-曼-惠特尼检验比较连续变量组间特征。
在本研究中，共评估了43521名个体，其中13770名（32%）来自LCS项目，29751名（68%）来自IPN项目。在IPN项目的29751名个体中，根据USPSTF 2021年标准，3840名（13%）符合LCS条件；根据IPN-波特标准，4905名（16%）符合条件；根据IPN-ACS标准，5263名（18%）符合条件；根据IPN-波特-ACS标准，6307名（21%）符合条件。根据IPN-波特标准，还有1103名个体符合条件（606名女性[55%]，382名黑人[35%]）；根据IPN-ACS标准，有1423名个体符合条件（628名女性[44%]；237名黑人[17%]）；根据IPN-波特-ACS标准，有2467名个体符合条件（1200名女性[49%]；615名黑人[25%]）。在IPN-波特标准和USPSTF 2021年标准之间，额外符合条件的女性个体数量（55%对48%；P＜0.001）和黑人个体数量（35%对22%；P＜0.001）存在显著差异。在13770名LCS参与者中，有504名（4%）被诊断为肺癌；在29751名IPN参与者中，有1714名（6%）被诊断为肺癌，包括根据IPN-波特标准符合条件的4905名中的872名（18%），根据IPN-ACS标准符合条件的5263名中的955名（18%），以及根据IPN-波特-ACS标准符合条件的6307名中的1051名（17%）。IPN项目中额外符合条件且患有肺癌的女性个体，根据IPN-波特标准为128名中的70名（55%），根据IPN-ACS标准为208名中的89名（43%），根据IPN-波特-ACS标准为304名中的143名（47%），IPN-波特标准和USPSTF 2021年标准之间存在统计学显著差异（55%对48%；P＜0.001）。额外符合条件且为黑人的个体，根据IPN-波特标准为128名中的50名（39%），根据IPN-ACS标准为208名中的32名（15%），根据IPN-波特-ACS标准为304名中的73名（24%），IPN-波特标准和IPN-USPSTF 2021年标准之间存在统计学显著差异（39%对22%；P＜0.001）。当LCS标准扩大到50岁以上且吸烟10年或10包年的个体时，IPN项目的29751名个体中有7993名（27%）符合条件。其中，7993名中有1251名（16%）被诊断为肺癌。
在这项队列研究中，将吸烟标准从20包年改为20年吸烟史与改善LCS可及性相关，同时保持诊断效率。应探索将标准扩展到有10年或10包年吸烟史的个体。
