Overdiagnosis of Lung Cancer Due to the Introduction of Low-Dose Computed Tomography in Average-Risk Populations in the People’s Republic of China

IF 21 1区医学 Q1 ONCOLOGY

Journal of Thoracic Oncology Pub Date : 2025-07-01 DOI:10.1016/j.jtho.2025.02.013

Dongchen Xie MD , Li Zhang MD , Na He MD, PhD , Chen Yang MD , Ruoxin Zhang MD, PhD , Haiquan Chen MD, PhD , Xing Liu MD, PhD , Chen Suo MD, PhD , Mengyan Wang MD , Yan Wei MD, PhD , Lipeng Hao BD , Wanghong Xu MD, PhD

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Abstract

Introduction

Low-dose computed tomography (LDCT) has been widely used in health check-ups in China since 2011. The introduction of LDCT in average-risk populations may have led to substantial overdiagnosis of lung cancer.

Methods

This registry-based study included 46,978 incident cases and 34,475 deaths of lung cancer derived from a population of approximately 3.21 million in the Pudong New Area of Shanghai, People’s Republic of China, from 2002 to 2020. We calculated the age-standardized rates of overall, stage- and histology-specific incidence and overall mortality by sex. The numbers and proportions of cases attributable to overdiagnosis were estimated on the basis of the comparison between the shape of the age-specific curve with that before the introduction of LDCT in average-risk populations since 2011.

Results

The age-standardized incidence of lung cancer increased rapidly since 2011 in both male and female individuals, whereas the age-standardized mortality declined over the period. The upward trends in incidence were mainly observed in women with early-stage cancer and lung adenocarcinoma. Overall, no significant overdiagnosis was observed in men, whereas the overdiagnosis rate grew from 22% in 2011 to 2015 to 50% in 2016 to 2020 in women. Further analysis reported elevated numbers (proportions) of lung adenocarcinoma cases attributable to overdiagnosis, which rose from 182 cases (8%) in 2011 to 2015 to 827 cases (22%) in 2016 to 2020 in men, and from 1842 cases (85%) to 4171 cases (89%) in women.

Conclusion

This study demonstrates considerable and increasing overdiagnosis of lung adenocarcinoma in Chinese men and women. The guideline is urgently needed to maximize the benefits of LDCT screening and reduce the potential overdiagnosis of lung cancer.

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中国平均风险人群中引入低剂量计算机断层扫描导致的肺癌过度诊断

背景：自2011年以来，低剂量计算机断层扫描（LDCT）在中国健康检查中得到广泛应用。在平均风险人群中引入LDCT可能导致肺癌的大量过度诊断。方法：这项基于登记的研究包括2002年至2020年中国上海浦东新区约321万人口中46,978例肺癌病例和34,475例肺癌死亡。我们按性别计算了总体、分期和组织学特异性发病率和总体死亡率的年龄标准化率。根据自2011年以来在平均风险人群中引入LDCT之前的年龄特异性曲线形状的比较，估计了可归因于过度诊断的病例数量和比例。结果：2011年以来，男性和女性肺癌的年龄标准化发病率均呈快速上升趋势，而同期年龄标准化死亡率呈下降趋势。发病率的上升趋势主要见于早期癌症和肺腺癌的妇女。总体而言，在男性中没有观察到明显的过度诊断，而在女性中，过度诊断率从2011-2015年的22%上升到2016-2020年的50%。进一步的分析显示，过度诊断导致的肺腺癌病例数量（比例）上升，男性从2011-2015年的182例（8%）上升到2016-2020年的827例（22%），女性从1842例（85%）上升到4171例（89%）。结论本研究表明，中国男性和女性肺腺癌的过度诊断相当多且呈上升趋势。为了最大限度地发挥LDCT筛查的益处，减少潜在的肺癌过度诊断，迫切需要该指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thoracic Oncology 医学-呼吸系统

CiteScore

36.00

自引率

3.90%

发文量

1406

审稿时长

13 days

期刊介绍： Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer,is the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies.The readship includes epidemiologists, medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, radiologists, pathologists, nuclear medicine physicians, and research scientists with a special interest in thoracic oncology.