肺癌筛查:美国癌症协会 2023 年指南更新

IF 503.1 1区 医学 Q1 ONCOLOGY CA: A Cancer Journal for Clinicians Pub Date : 2023-11-01 DOI:10.3322/caac.21811
Andrew M. D. Wolf MD, Kevin C. Oeffinger MD, Tina Ya-Chen Shih PhD, Louise C. Walter MD, Timothy R. Church PhD, Elizabeth T. H. Fontham MPH, DrPH, Elena B. Elkin PhD, MPA, Ruth D. Etzioni PhD, Carmen E. Guerra MD, MSCE, Rebecca B. Perkins MD, MSc, Karli K. Kondo PhD, Tyler B. Kratzer MPH, Deana Manassaram-Baptiste PhD, MPH, William L. Dahut MD, Robert A. Smith PhD
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引用次数: 0

摘要

肺癌是导致美国男性和女性癌症死亡率和寿命损失的主要原因。研究表明,早期发现可降低肺癌死亡率。我们的目标是更新美国癌症协会(ACS)2013 年肺癌高风险成人肺癌筛查(LCS)指南。该指南旨在为医疗服务提供者及其因吸烟史而罹患肺癌的高危患者提供筛查指导。ACS 指南制定小组(GDG)利用了为美国预防服务工作组 2021 年 LCS 建议更新而委托进行的 LCS 文献系统综述;与戒烟年限(YSQ)相关的肺癌风险的第二次系统综述;2021 年以来发表的文献;两个经癌症干预和监测建模网络验证的肺癌模型,用于评估筛查的益处和危害;一项流行病学和建模分析,研究 YSQ 和老龄化对肺癌风险的影响;以及对 LCS 和随访检查中的获益与辐射风险比的最新分析。GDG 还研究了美国国家癌症研究所的监测、流行病学和最终结果项目中的疾病负担数据。建议的制定基于证据的质量以及对利弊平衡的判断(包括价值观和偏好)。GDG 认为总体证据质量适中,足以支持对符合资格标准的个体进行筛查的强烈建议。在一系列研究设计中,50-80 岁男性和女性的肺结核筛查与肺癌死亡的减少有关,推论证据支持对 80 岁以上健康状况良好的男性和女性进行肺结核筛查。ACS 建议,对于 50-80 岁无症状、目前吸烟或曾吸烟且吸烟史≥20 包年的人,每年进行一次低剂量计算机断层扫描肺癌筛查(强烈推荐,证据质量中等)。在决定开始 LCS 前,患者应与有资质的医疗专业人员进行共同决策讨论。对于曾经吸烟的个体,YSQ的数量并不是开始或停止筛查的资格标准。目前吸烟的个人应接受戒烟咨询,并联系戒烟资源。患有严重限制预期寿命的并发症的个体不应接受筛查。医疗服务提供者和肺癌高危成人在讨论肺癌筛查时应考虑这些建议。如果这些建议得到充分实施,将很有可能显著减少美国肺癌患者的死亡和痛苦。
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Screening for lung cancer: 2023 guideline update from the American Cancer Society

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50–80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

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来源期刊
CiteScore
873.20
自引率
0.10%
发文量
51
审稿时长
1 months
期刊介绍: CA: A Cancer Journal for Clinicians" has been published by the American Cancer Society since 1950, making it one of the oldest peer-reviewed journals in oncology. It maintains the highest impact factor among all ISI-ranked journals. The journal effectively reaches a broad and diverse audience of health professionals, offering a unique platform to disseminate information on cancer prevention, early detection, various treatment modalities, palliative care, advocacy matters, quality-of-life topics, and more. As the premier journal of the American Cancer Society, it publishes mission-driven content that significantly influences patient care.
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