Lauren E Kearney, Patrick Belancourt, Hormuzd A Katki, Nichole T Tanner, Renda Soylemez Wiener, Hilary A Robbins, Rebecca Landy, Tanner J Caverly
{"title":"肺癌筛查替代标准的制定与实施。","authors":"Lauren E Kearney, Patrick Belancourt, Hormuzd A Katki, Nichole T Tanner, Renda Soylemez Wiener, Hilary A Robbins, Rebecca Landy, Tanner J Caverly","doi":"10.7326/M23-3250","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.</p><p><strong>Objective: </strong>To determine whether alternative criteria can identify these high-benefit people.</p><p><strong>Design: </strong>Model-based projections.</p><p><strong>Setting: </strong>United States.</p><p><strong>Participants: </strong>People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.</p><p><strong>Measurements: </strong>Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. \"High-benefit\" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.</p><p><strong>Results: </strong>The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; <i>P</i> < 0.001) and specificity (86% vs. 84%; <i>P</i> < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [<i>P</i> < 0.001]; Hispanic: 95% vs. 73% [<i>P</i> = 0.086]; Asian: 94% vs. 68% [<i>P</i> = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities.</p><p><strong>Limitation: </strong>The results were based on model projections.</p><p><strong>Conclusion: </strong>These results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups.</p><p><strong>Primary funding source: </strong>U.S. Department of Veterans Affairs Lung Precision Oncology Program.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":null,"pages":null},"PeriodicalIF":19.6000,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Development and Performance of Alternative Criteria for Lung Cancer Screening.\",\"authors\":\"Lauren E Kearney, Patrick Belancourt, Hormuzd A Katki, Nichole T Tanner, Renda Soylemez Wiener, Hilary A Robbins, Rebecca Landy, Tanner J Caverly\",\"doi\":\"10.7326/M23-3250\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.</p><p><strong>Objective: </strong>To determine whether alternative criteria can identify these high-benefit people.</p><p><strong>Design: </strong>Model-based projections.</p><p><strong>Setting: </strong>United States.</p><p><strong>Participants: </strong>People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.</p><p><strong>Measurements: </strong>Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. \\\"High-benefit\\\" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.</p><p><strong>Results: </strong>The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; <i>P</i> < 0.001) and specificity (86% vs. 84%; <i>P</i> < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [<i>P</i> < 0.001]; Hispanic: 95% vs. 73% [<i>P</i> = 0.086]; Asian: 94% vs. 68% [<i>P</i> = 0.171]) at similar specificity. 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The Development and Performance of Alternative Criteria for Lung Cancer Screening.
Background: The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.
Objective: To determine whether alternative criteria can identify these high-benefit people.
Design: Model-based projections.
Setting: United States.
Participants: People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.
Measurements: Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. "High-benefit" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.
Results: The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; P < 0.001) and specificity (86% vs. 84%; P < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [P < 0.001]; Hispanic: 95% vs. 73% [P = 0.086]; Asian: 94% vs. 68% [P = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities.
Limitation: The results were based on model projections.
Conclusion: These results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups.
Primary funding source: U.S. Department of Veterans Affairs Lung Precision Oncology Program.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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