肺癌筛查资格标准修改对种族和性别差异的潜在影响

SCI

17 October 2022

Potential Impact of Criteria Modifications on Race and Sex Disparities in Eligibility for Lung Cancer Screening

（J Thorac Oncol;IF:20.121）

• Smeltzer MP, Liao W, Faris NR et al. Potential Impact of Criteria Modifications on Race and Sex Disparities in Eligibility for Lung Cancer Screening. J Thorac Oncol 2022. DOI: 10.1016/j.jtho.2022.09.220

• Correspondence to:Corresponding author:Raymond U. Osarogiagbon, MBBS、6141 Walnut Grove Road, Second Floor、Memphis, TN 38139、Email: rosarogi@bmhcc.org

Introduction 介绍

Low Dose CT screening (LDCT) reduces lung cancer mortality, but current eligibility criteria underestimate risk in women and racial minorities. We evaluated the impact of screening criteria modifications on LDCT eligibility and lung cancer detection.

低剂量CT筛查(LDCT)降低肺癌死亡率，但目前的资格标准低估了妇女和少数种族的风险。我们评估了筛查标准修改对LDCT合格性和肺癌检测的影响。

Methods 方法

Using data from a Lung Nodule Program, we compared persons eligible for LDCT by: US Preventive Services Task Force (USPSTF) 2013 criteria (55-80 years, ≥30 pack-years of smoking, and ≤15 years since cessation (USPSTF2013); USPSTF 2021 (50-80 years, ≥20 pack-years of smoking, and ≤15 years since cessation (USPSTF2021); quit duration expanded to ≤25 years (USPSTF2021-QD25); reducing the pack-years of smoking to ≥10 (USPSTF2021- PY10); and both (USPSTF2021-QD25-PY10). We compare across groups using the chi-square test or Analysis of Variance.

使用肺结节项目的数据，我们比较符合低剂量CT标准的人群:美国预防服务工作组(USPSTF) 2013标准(55-80岁，≥30包年吸烟，戒烟后≤15年(USPSTF2013);USPSTF2021(50-80年，吸烟≥20包年，戒烟后≤15年(USPSTF2021);戒烟持续时间扩大至≤25年(USPSTF2021-QD25);将吸烟包年减少到≥10年(USPSTF2021- PY10)(USPSTF2021-QD25-PY10)。我们使用卡方检验或方差分析进行组间比较。

Results 结果

The 17,421 individuals analyzed were 56% female, 69% White, 28% Black; 13% met USPSTF2013 criteria; 17% USPSTF2021; 18% USPSTF2021-QD25; 19% USPSTF2021-PY10; and 21% USPSTF2021-QD25-PY10. Additional eligible individuals by USPSTF2021 (n=682) and USPSTF2021-QD25-PY10 (n=1402) were 27% and 29% Black, both significantly higher than USPSTF2013 (17%, pvalues< 0.0001). These additional eligible individuals were 55% (USPSTF2021) and 55% (USPSTF2021-QD25-PY10) female, compared to 48% by USPSTF2013 (p-values< 0.05). Of 1,243 (7.1%) persons with lung cancer, 22% were screening-eligible by USPSTF13. USPSTF2021-QD25-PY10 increased the total number of persons with lung cancer by 37%. These additional individuals with lung cancer were 57% female (vs 48% with USPSTF2013, pvalue= 0.0476) and 24% black (vs 20% with USPSTF2013, p-value= 0.3367).

分析的17,421个个体中56%为女性，69%为白人，28%为黑人;13%符合USPSTF2013标准;USPSTF2021 17%;USPSTF2021-QD25 18%;USPSTF2021-PY10 19%;和21% USPSTF2021-QD25-PY10。USPSTF2021 (n=682)和USPSTF2021- QD25 - PY10 (n=1402)附加的合格个体为27%和29%的黑人，均显著高于USPSTF2013 (17%， pvalues<0.0001)。这些额外的符合条件的个体为55% (USPSTF2021)和55% (USPSTF2021- QD25 - PY10)女性，而USPSTF2013 (p-values<0.05)。在1243名(7.1%)肺癌患者中，22%符合USPSTF13筛查条件。USPSTF2021-QD25-PY10使肺癌患者总数增加了37%。这些新增的肺癌患者中57%为女性(USPSTF2013组为48%，p值= 0.0476)，24%为黑人(USPSTF2013组为20%，p值= 0.3367)。

Conclusion 结论

Expansion of LDCT screening eligibility criteria to allow longer quit-duration and fewer packyears of exposure enriches the screening-eligible population for women and Black persons.

扩大LDCT筛查资格标准，允许更长的退出时间和更少的暴露年数，丰富了妇女和黑人筛查合格人群。

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