Brief Report: Impact of joint lung cancer screening and cessation interventions under the new USPSTF recommendations
Menée aux Etats-Unis auprès de la cohorte de naissance de 1960 (4,5 millions d'individus), cette étude analyse l'efficacité, du point de vue des décès par cancer du poumon évités et des années de vie gagnées, d'une intervention associant un dépistage par tomodensitométrie faible dose et un sevrage tabagique
Background: In 2021, the USPSTF revised its lung cancer screening recommendations expanding its eligibility. As more smokers become eligible, cessation interventions at the point of screening could enhance the benefits. Here we assess the effects of joint screening and cessation interventions under the new recommendations. Methods: A validated lung cancer natural history model was used to estimate lifetime number of low-dose computed tomography (LDCT) screens, percentage ever screened, lung cancer deaths, lung cancer deaths averted and life-years gained for the 1960 US birth cohort aged 45 through 90 years (4.5 million individuals). Screening occurred according to USPSTF 2013 and 2021 recommendations with varying uptake (0%, 30%, 100%), with or without a cessation intervention at the point of screening with varying effectiveness (15%, 100%). Results: Screening 30% of the eligible population according to 2021 criteria with no cessation intervention (USPSTF2021/30%_uptake/without_cessation) was estimated to result in 6,845 lung cancer deaths averted and 103,725 life-years gained. These represent 28% and 34% increases, respectively, relative to screening according to 2013 guidelines (USPSTF2013/30%/without). Adding a cessation intervention at the time of the first screen with 15% effectiveness (USPSTF2021/30%/with_15%) was estimated to result in 2,422 additional lung cancer deaths averted (9,267 total,
∼
73% increase vs USPSTF2013/30%/without) and 322,785 life-years gained (
∼
318% increase). Screening 100% of the eligible according to 2021 guidelines with no cessation intervention (USPSTF2021/100%/without) was estimated to result in 23,444 lung cancer deaths averted (
∼
337% increase vs USPSTF2013/30%/without) and 354,330 life-years gained (
∼
359% increase). Adding a cessation intervention with 15% effectiveness (USPSTF2021/100%/with_15%) would result in 31,998 lung cancer deaths averted (
∼
497% increase vs USPSTF2013/30%/without) and 1,086,840 life-years gained (
∼
1,309% increase). Conclusions: Joint screening and cessation interventions would result in considerable lung cancer deaths averted and life-years gained. Adding a one-time cessation intervention of modest effectiveness (15%) results in comparable life-years gained as increasing screening uptake from 30% to 100% because while cessation decreases mortality from many causes, screening only reduces lung cancer mortality. This simulation indicates that incorporating cessation programs into screening practice should be a priority as it can maximize overall benefits.