"The Lancet Respiratory Medicine": One Million Chinese People's Congress Survey!

If the "king of all diseases" cancer is also divided into three, six and nine, lung cancer can definitely be regarded as "full of evil"
.

But the good news is that an early-stage lung cancer screening method has recently been validated in a large population-based study
.

Recently, the research team of Academician He Jie from the National Cancer Research Center of Cancer Hospital, Chinese Academy of Medical Sciences published a study on lung cancer screening and effect evaluation of China's disposable low-dose spiral CT (LDCT) in the journal "The Lancet Respiratory Medicine".
Results [1]
.

The research team analyzed the 1,016,740 participants and found that the risk of lung cancer in the LDCT screening group was 47.
0% higher than that in the non-screening group, and the lung cancer mortality and all-cause mortality in the screening group were lower than those in the non-screening group.
31.
0% and 32.
0%
.

This prospective study is the first to demonstrate the effectiveness of a one-time LDCT screening strategy in a population of millions
.

One-time LDCT was significantly associated not only with increased detection of lung cancer in high-risk groups, but also with decreased lung cancer-related and all-cause mortality
.

The differences in the results of subgroup analysis also provide an important reference for the formulation of population screening strategies for lung cancer in the future
.

The title of the article shows that lung cancer accounts for 11.
4% of the global cancer incidence and 18.
0% of cancer-related all-cause deaths [2]
.

Lung cancer-related deaths in China account for 23.
8% of all cancer deaths [3], bringing a huge burden to the family and society
.

It is urgent to solve the problems of early prevention, early screening and early treatment of lung cancer
.

In previous randomized controlled trials, LDCT screening can reduce lung cancer mortality by 20-26% [4-6]
.

However, existing lung cancer screening studies often include multiple LDCT examinations [4-9], which increases the cost and reduces the feasibility of similar programs in countries with limited medical resources such as China
.

Can a one-time LDCT examination reduce lung cancer mortality and all-cause mortality in the population? With this question in mind, the researchers conducted a nationwide collection and analysis of receipts
.

This study relies on the National Lung Cancer Screening Program and includes residents aged 40-74 with no symptoms of lung cancer and no history of cancer from 8 provinces, 12 cities, and 458 communities across the country
.

The researchers screened candidate study participants, collected exposure information on important lung cancer risk factors, and assessed the risk of lung cancer in men and women based on a specific scoring system [10], dividing the population into high-risk lung cancer and low-risk lung cancer groups.
group
.

People with a higher risk of lung cancer were advised to receive a free LDCT examination in a designated tertiary hospital, and received detailed LDCT risk and benefit information education before making a decision on whether to check
.

Groups at high risk of lung cancer who underwent a one-time LDCT were assigned to the screening group, high-risk individuals who were not screened were assigned to the unscreened group, and the rest were assigned to the low-risk group
.

The primary outcomes of the study were defined as lung cancer incidence, lung cancer mortality, and all-cause mortality, and secondary outcomes were defined as the proportion of participants diagnosed with early-stage (stage 0-1) lung cancer
.

Outcome information was regularly extracted from national cancer registries and death surveillance systems
.

Between February 19, 2013, and October 31, 2018, 1,032,639 subjects were assessed for eligibility for participation, and 1,016,740 participants participated in the study, including 79,581 in the screened group and 79,581 in the unscreened group.
143,721 people and 793,438 people in the low-risk group
.

During a median follow-up of 3.
6 years (interquartile range: 2.
8-5.
1 years), 3581 people were diagnosed with lung cancer
.

The main outcome of the study, the risk of lung cancer in the LDCT screening group was 47.
0% higher than that in the unscreened group (HR: 1.
47, 95% CI: 1.
27-1.
70), and the risk of lung cancer death in the screened group was 31.
0% lower than that in the unscreened group ( HR: 0.
69, 95%CI: 0.
53-0.
92), and the risk of all-cause mortality was 32.
0% lower (HR: 0.
68, 95%CI: 0.
57-0.
82)
.

The proportion of stage 0-1 lung cancer was 62.
7% in the screened group, 55.
7% in the low-risk group, and only 41.
5% in the unscreened group
.

Subgroup analysis suggested that the significant associations between one-time LDCT screening and reduction in lung cancer mortality/all-cause mortality in high-risk lung cancer groups were mainly found in males, 55-74 years old, and living in high-income areas such as Beijing, Zhejiang, and Jiangsu.
as well as subgroups such as heavy smokers (20 years or more of a pack-a-day smoking history)
.

Results of a subgroup analysis of lung cancer-related and all-cause mortality This study is the first prospective study completed in a very large population to demonstrate a one-time LDCT screening and reductions in lung cancer and all-cause mortality in a high-risk group for lung cancer There was a significant association between them, supporting the decision-making feasibility of one-time LDCT screening for a wider range of high-risk lung cancer groups
.

Future lung cancer early screening projects are expected to significantly reduce the burden of lung cancer disease in China without causing huge pressure on the resources of the medical system
.

Interestingly, one-time LDCT screening can also assist in the screening of diseases other than lung cancer, such as the early diagnosis of cardiovascular diseases and respiratory diseases.
These unexpected findings may advance the treatment and secondary prevention of related diseases, which in turn will lead to early diagnosis of related diseases.
The significant benefit to patients may be one of the potential reasons for the reduction in all-cause mortality in the screening group
.

The characteristics of the beneficiary population suggested by the subgroup analysis can provide an important reference for the future population standards for early lung cancer screening.
Heavy smokers, men, and people over 55 years old may need to pay special attention.
After consulting clinicians, consider making full use of them.
The screening value of one-time LDCT to achieve early diagnosis of lung cancer, thereby reducing disease risk
.

At the same time, this study also has certain limitations
.

For example, the representativeness of the sampling method may have certain defects; the median follow-up time of 3.
6 years is slightly insufficient for analyzing long-term outcomes; the outcome data comes from the national cancer registry and death surveillance system, and the data of some patients may not be accurate enough.
There are risks of data loss and misclassification; the compliance of one-time LDCT is only 35.
6%, which is significantly lower than the proportion in randomized controlled trials; confounding factors such as the accessibility of medical resources and mobility of different patients may also affect the accuracy of the research conclusions Sex, but the flaws do not hide the beauty
.

Under the background that the new crown is still raging around the world, people have paid sufficient attention to the health of the lungs
.

Increased adherence to LDCT screening may enable early diagnosis and treatment of more lung cancer patients, leading to better clinical outcomes
.

The value of one-time LDCT screening confirmed by this study deserves the attention of policy makers, public health practitioners, and everyone with high risk factors for lung cancer
.

There is no doubt about the value of LDCT, but we must not forget that the intervention of lung cancer risk factors is the best way to reduce the risk of the disease
.

The organ that diligently completes the gas exchange deserves more care and attention from everyone
.

Reference: [1] Li N, Tan F, Chen W, et al.
One-off low-dose CT for lung cancer screening in China: a multicentre, population-based, prospective cohort study [published online ahead of print, 2022 Mar 8].
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2022;S2213-2600(21)00560-9.
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Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries.
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2021;71(3):209-249.
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0b013e3181a0d98f[9] Infante M, Cavuto S, Lutman FR, et al.
Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography.
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1023/a:1008984432272 Editor-in-Chief | Dai SiyuHarvard report on cancer prevention volume 4: Harvard Cancer Risk Index.
Risk Index Working Group, Harvard Center for Cancer Prevention.
Cancer Causes Control.
2000;11(6):477-488.
doi:10.
1023/a:1008984432272 Managing Editor | silk rainHarvard report on cancer prevention volume 4: Harvard Cancer Risk Index.
Risk Index Working Group, Harvard Center for Cancer Prevention.
Cancer Causes Control.
2000;11(6):477-488.
doi:10.
1023/a:1008984432272 Managing Editor | silk rain