When does lung cancer screening start and do?Domestic and foreign guidelines

Author:Cancer Channel of the Medical Time:2022.07.21

*For medical professionals for reading reference

Come and see if you are a high -risk crowd!

Lung cancer is the highest incidence and mortality cancer in China, and one of the major diseases that seriously threaten people's lives and health. Data show that about 37%of the new cases of lung cancer in 2020 came from China. In cases of lung cancer death, Chinese cases accounted for about 39.8%of them.

"Early diagnosis and early treatment" is the most important and most effective way to increase the survival rate of patients with lung cancer and reduce the mortality rate of patients. Therefore, the screening of lung cancer in high -risk people in lung cancer is the basis of "early diagnosis and early treatment" of patients with lung cancer, and is a key factor in reducing its mortality and extending survival rate.

Which people need to screen? Let's see what the major guidelines say!

USPSTF Guide:

The age of lung cancer screening should be advanced to 50!

On October 12, the US Prevention Service Working Group (USPSTF) updated the proposal of lung cancer screening in 2021 [1,2], further expanding the scope of lung cancer screening groups.

Previous edition (2013 version) USPSTF guide recommends that the 55-80-year-old adult, smoking intensity in 30 packs (year-old = number of daily smoking × smoking years), as well as crowds of quitting time <15 years, Low -dose spiral CT (LDCT) lung cancer screening is performed each year.

The 2021 version of the USPSTF guide will advance the age of the lung cancer screening crowd to the age of 50, and it is recommended to reduce the year of smoking from 30 packs to 20 packs. "The ranks.

This guide is updated, according to the report of Nelson Studies [3], the Nelson research results show that at the age of 50-74, smoking history is ≥15 daily, duration of ≥ 25 years, or smoking every day ≥10 The duration, the duration of ≥ 30 years, and the smoking cessation time of the smoking time, compared with the people who do not screen, the lung cancer mortality rate of LDCT screening has been performed in 5.5 years. Essence

How to screen for high -risk people? Look at the recommendation of domestic and foreign guidelines

Due to the large differences between the characteristics of the domestic population and the Western population, the characteristics of domestic tumor epidemic disease are also different from foreign countries. The relevant indicators in foreign lung cancer screening guidelines may not be fully applied to China, which has also led to China and the United States guide. The definition is slightly different.

1. Compared with foreign guidelines, domestic guidelines are more advanced on the age of screening crowds.

Whether it is the updated USPSTF guide, or the domestic comprehensive cancer network (NCCN) guidelines [4,5], or the Guide of the American Chemical Physician (ACCP) guide [6] The age of lung cancer screening is limited to 55 years old.

Many domestic guidelines recommend those over 50 years of age, and they have begun to receive lung cancer screening, and "Consensus on the Screening and Management of Chinese Experts (2019)" [7] is recommended to conduct lung cancer screening. Essence

Academician Herje's Journal of Thoracic OnCology Magazine introduced the current status of Chinese lung cancer screening prevention and control and the progress of treatment progress. Under 40 years of age, the incidence of lung cancer in a certain age group was relatively low. Since then, it has risen sharply. Both men and women from the age of 80 to 84 reached their peaks. Prior to this, the incidence of lung cancer was significantly lower than men.

Figure 1 The incidence and mortality of the specific age group of each 100,000 population in 2014

2. Domestic guidelines to divide the boundary of the smoking intensity of the screening crowd is more advanced

In addition to the age of screening, there are also certain differences in the screening of smoking history of smoking people. Although the USPSTF guide this update has reduced the screening limit of smoking in smoking from 30 packs to 20 packs, many foreign guidelines abroad guidelines People who still use smoking history ≥30 packs are regarded as high -risk groups of lung cancer, and most domestic guidelines generally recommend people with smoking history ≥20 packs for lung cancer screening.

A META analysis included in 19 queue studies [8] showed that the risk and death risk of smokers were 13.1 times (HR: 13.1, 95%CI: 9.90-17.3) and 11.5 times (HR: 13.1, 95%CI: 9.90-17.3). : 11.5, 95%CI: 8.21-16.1); the risk and death risk of lung cancer in smokers were 4.06 times (HR: 4.06, 95%CI: 3.13-5.26) and 4.10 times (HR: 4.10 , 95%CI: 3.14-5.36).

Another study [9] data shows that the risk of lung cancer is 1.90 times the risk of lung cancer (RR: 1.90, 95% CI: 1.72-2.10), 2.68 times (OR: 2.68, 95%CI: 2.49-2.89) and 3.59 times (RR: 3.59, 95%CI: 3.22-3.99), and the risk of illness is positively correlated with smoking intensity (p: P <0.0001), the longer the history of smoking, the greater the intensity of smoking, and the higher the risk of lung cancer.

Table 1 Definition of domestic and foreign guidelines to define lung cancer high -risk people

In March of this year, the "Guide to China Cancer Screening and Early Creed Early Treatment (2021, Beijing)" (hereinafter referred to as the "Guide") [10] was released. Explained. The "Guide" clearly states that the high -risk factors of lung cancer include: smoking, second -hand smoke exposure;

Chronic obstructive lung disease (Chronic ObStructive Pulmonary Disease (COPD); COPD;

FIRST Degree Relative (FDR) family history of lung cancer;

Asbestos, tadpoles, chromium, chromium, cadmium, nickel, silicon, tobacco, and cubes and dust exposure

In addition, genetic factors also have an important role in the occurrence and development of lung cancer.

The "Guide" also explains the protection of lung cancer while clarifying the risk factors of lung cancer. The "Guide" emphasizes reasonable physical exercise and fresh vegetables and fruits. Studies have shown that exercise can reduce the risk of lung cancer by 25.0%, and people with high intake of fruits and vegetables have a lower risk of lung cancer than those with lower intake of 14.0%.

The "Guide" recommends that people who are 50-74 years old and have any of the following people to screen:

(A) Smoking: The number of smoking packages is ≥30 pack years, including the number of smoking packages ≥30 packs, but less than 15 years of quitting;

(B) Passive smoking: live with the smokers or work in the same room ≥ 20 years;

(D) There is a history of occupational exposure (asbestos, tadpoles, chromium, chromium, cadmium, nickel, silicon, cubes, smoke, and soot) at least 1 year;

(E) There are first -level relatives to diagnose lung cancer.

Figure 2 Cancer screening process

It is worth noting that in the "Guidelines", the age of the crowd of lung cancer screening and the boundaries of smoking history is not consistent with the general "consensus" in China. We took it lightly. In particular, the problem of second -hand cigarettes in my country is serious. The "Guide" emphasizes that passive smoking smoking should also conduct lung cancer screening for more than 20 years.

The opportunity for early lung cancer to be cured is very large, so the screening of lung cancer is essential for the treatment of lung cancer. Lung cancer may be far away from us, or it may be very close to us. What we can do is "anti -micro -duct", stifling possible cancer risks in the puppet!

Reference materials:

[1]Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784816

[2]Screening for Lung Cancer With Low-Dose Computed Tomography Updated Evidence Report and Systematic Review for the US Preventive Services Task Force https://jamanetwork.com/journals/jama/fullarticle/2777242

[3] Characteristics of New Solid Nodules Detected in Incidence Screening Rounds of Low-Dose CT LUNG CANCER Screening: The Nelson Study Https://thorax.bmj.com/73/8/741/741/741

[4] NCCN Guidelines for Patients.lung Cancer Screening, 2020 https://www.nccn.org/patients/guidelines/Content/pdf/lung_screening-pdf.pdf

[5] LUNG CANCER Screening, Version 1.2021, NCCN Clinical Practice Guidelines in onCology https://www.nccn.org/professionals/pdf/lung_screening.pdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfdfd

[6] Peter J. Mazzone et al, Screening for LUNG CANCER: Chest Guideline and Expert Panel Report, Chest (2021). Doi: 10.1016/J.CHEST.2021.06.063. Respiratory Diseases Branch of the Lung Cancer, the Chinese Physician Association Respirators Branch, the lung cancer work committee, lung cancer screening and management of the consensus of Chinese experts [J]. International respiratory magazine. 2019,39 (21): 1604-1615.

[8] He Jie, Li Ni, Chen Wanqing, etc. The Guide of China Cancer Screening and Early Treatment (2021, Beijing) [J]. Chinese Oncology Magazine, 2021, 43 (03): 243-268.

[9] Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium[J]. BMC Medicine, 2016, 14(1):1-15.

[10] Chen W, Zheng R, Baade P D, et al. Cancer Statistics in China, 2015. 2013.

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