Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study
BackgroundLow-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. ObjectiveThis study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-03-01
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| Series: | JMIR Public Health and Surveillance |
| Online Access: | https://publichealth.jmir.org/2023/1/e43586 |
| _version_ | 1797734311718289408 |
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| author | Le Wang Youqing Wang Fei Wang Yumeng Gao Zhimei Fang Weiwei Gong Huizhang Li Chen Zhu Yaoyao Chen Lei Shi Lingbin Du Ni Li |
| author_facet | Le Wang Youqing Wang Fei Wang Yumeng Gao Zhimei Fang Weiwei Gong Huizhang Li Chen Zhu Yaoyao Chen Lei Shi Lingbin Du Ni Li |
| author_sort | Le Wang |
| collection | DOAJ |
| description |
BackgroundLow-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce.
ObjectiveThis study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers.
MethodsA population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups.
ResultsAt baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17).
ConclusionsLDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed. |
| first_indexed | 2024-03-12T12:42:25Z |
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| id | doaj.art-744d569dba9a46859083ac98b04e8cc0 |
| institution | Directory Open Access Journal |
| issn | 2369-2960 |
| language | English |
| last_indexed | 2024-03-12T12:42:25Z |
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| spelling | doaj.art-744d569dba9a46859083ac98b04e8cc02023-08-28T23:45:41ZengJMIR PublicationsJMIR Public Health and Surveillance2369-29602023-03-019e4358610.2196/43586Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort StudyLe Wanghttps://orcid.org/0000-0002-6142-7134Youqing Wanghttps://orcid.org/0000-0002-1408-7667Fei Wanghttps://orcid.org/0000-0002-0947-008XYumeng Gaohttps://orcid.org/0000-0001-5755-538XZhimei Fanghttps://orcid.org/0000-0001-9732-1430Weiwei Gonghttps://orcid.org/0000-0002-7066-4772Huizhang Lihttps://orcid.org/0000-0002-4120-0119Chen Zhuhttps://orcid.org/0000-0002-4079-6491Yaoyao Chenhttps://orcid.org/0000-0002-6339-0857Lei Shihttps://orcid.org/0000-0003-0031-2808Lingbin Duhttps://orcid.org/0000-0002-1992-7784Ni Lihttps://orcid.org/0000-0001-5530-7745 BackgroundLow-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. ObjectiveThis study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. MethodsA population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. ResultsAt baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). ConclusionsLDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed.https://publichealth.jmir.org/2023/1/e43586 |
| spellingShingle | Le Wang Youqing Wang Fei Wang Yumeng Gao Zhimei Fang Weiwei Gong Huizhang Li Chen Zhu Yaoyao Chen Lei Shi Lingbin Du Ni Li Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study JMIR Public Health and Surveillance |
| title | Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study |
| title_full | Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study |
| title_fullStr | Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study |
| title_full_unstemmed | Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study |
| title_short | Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study |
| title_sort | disparity in lung cancer screening among smokers and nonsmokers in china prospective cohort study |
| url | https://publichealth.jmir.org/2023/1/e43586 |
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