Expanded Access to Lung Cancer Screening—Implementing Wisely to Optimize Health
Ce dossier présente un ensemble d'éditoriaux sur le dépistage des cancers du poumon
Lung cancer remains the number one cause of cancer deaths in the US, with smoking accounting for approximately 90% of cases. Although smoking rates have declined to historic lows, millions of people in the US remain at elevated risk owing to a lifetime of accumulated tobacco exposure. Lung cancer screening (LCS) with annual low-dose computed tomography (LDCT) aims to reduce cancer mortality through increased lung cancer detection at a curable stage. Randomized clinical trial results, such as the National Lung Screening Trial (NLST), led the US Preventive Services Task Force (USPSTF) in 2014 to recommend LCS for adults in generally good health and at high lung cancer risk based on age and smoking history. New data led the USPSTF to commission an updated evidence review and modeling report to inform revised recommendations to better optimize population benefits. The USPSTF now recommends expanding LCS to younger and less intensive smokers, defined as adults aged 50 to 80 years with 20 or more pack-years of smoking history who currently smoke or, as previously, have quit smoking within the past 15 years (B recommendation, moderate certainty of moderate net benefit). The USPSTF concluded that new recommendations could lead to important gains, such as an estimated increase 122 averted lung cancer deaths per 100 000 adults in the population (381 estimated averted deaths per 100 000 adults in the population with the old recommendations vs 503 estimated averted deaths per 100 000 adults in the population with the new recommendations) and 2035 life-years gained (4882 estimated life-years gained with the old recommendations vs 6918 estimated life-years gained with the new recommendations). However, these benefits could come at the expense of increased harms, including deaths associated with radiation exposure, false-positive screening results, overdiagnosed cancers, and incidental findings requiring evaluation.
JAMA Network Open , éditorial en libre accès, 2020