Effectiveness Evaluation of Low-dose Spiral Computed Tomography
for Lung Cancer Screening in Minhang District of Shanghai.
10.3779/j.issn.1009-3419.2023.102.46
- Author:
Jiaoyue TENG
1
;
Weiyuan YAO
1
;
Weixi LI
2
;
Yingling CHENG
2
;
Jun LI
2
;
Huilin XU
2
;
Wanghong XU
1
Author Information
1. Fudan University School of Public Health, Shanghai 200032, China.
2. Center for Disease Prevention and Control in Minhang District of Shanghai, Shanghai 201103, China.
- Publication Type:Journal Article
- Keywords:
Early diagnosis;
Low-dose spiral computed tomography;
Lung neoplasms;
Screening
- MeSH:
Adult;
Humans;
Lung Neoplasms/epidemiology*;
Tomography, X-Ray Computed;
Early Detection of Cancer/methods*;
China/epidemiology*;
Tomography, Spiral Computed/methods*;
Mass Screening
- From:
Chinese Journal of Lung Cancer
2024;27(1):13-24
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND:Low-dose spiral computed tomography (LDCT) has been recommended for lung cancer screening in high-risk populations. However, evidence from Chinese populations was limited due to the different criteria for high-risk populations and the short-term follow-up period. This study aimed to evaluate the effectiveness in Chinese adults based on the Lung Cancer Screening Program in Minhang District of Shanghai initiated in 2013.
METHODS:A total of 26,124 subjects aged 40 years or above were enrolled in the Lung Cancer Screening Program during the period of 2013 and 2017. Results of LDCT examination, and screen-detected cancer cases in all participants were obtained from the Reporting System of the Lung Cancer Screening Program. The newly-diagnosed cases and their vital status up to December 31, 2020 were identified through a record linkage with the Shanghai Cancer Registry and the Shanghai Vital Statistics. Standardized incidence ratio (SIR) and 95%CI were calculated using the local population at ages of 40 or above as the reference. Proportions of early-stage cancer (stage 0-I), pathological types, and 5-year observed survival rates of lung cancer cases were estimated and compared between the cases derived from the screened and non-screened populations. Cox regression models were applied to evaluate the hazard ratio (HR) and 95%CI of LDCT screening with all-cause death of the lung cancer cases.
RESULTS:The crude and age-standardized incidence of lung cancer in screened population were 373.3 (95%CI: 343.1-406.1) and 70.3 per 100,000 person-years, respectively, with an SIR of 1.8 (95%CI: 1.6-1.9), which was observed to decrease with following-up time. The early-stage cancer accounted for 49.4% of all lung cancer cases derived from the screened population, significantly higher than 38.4% in cases from the non-screened population during the same period (P<0.05). The proportion of lung adenocarcinoma (40.7% vs 35.9%) and 5-year survival rate (53.7% vs 41.5%) were also significantly higher in the cases from the screened population (all P<0.05). LDCT screening was associated with 30% (HR=0.7, 95%CI: 0.6-0.8) reduced all-cause deaths of the cases.
CONCLUSIONS:The participants of the screening program are at high-risk of lung cancer. LDCT favors the early-detection of lung cancer and improves 5-year survival of the screened cases, indicating a great potential of LDCT in reducing the disease burden of lung cancer in Chinese populations.
