Improving Eligibility Criteria for Lung Cancer Screening—Promises, Challenges, and Unmet Needs
Menée aux Etats-Unis à partir de données portant sur 105 261 adultes ayant des antécédents de tabagisme (âge moyen : 59,8 ans ; 57 % d'hommes), cette étude évalue, en fonction de l'origine ethnique et par rapport aux recommandations 2021 de l'"US Preventive Services Task Force", la performance du modèle PLCOm2012, basé sur des facteurs de risque, pour prédire le risque à 6 ans de cancer du poumon
The implementation of populationwide lung cancer screening (LCS) in the US over the past 10 years has fallen considerably short of its goals, leading to disappointment and frustration for varied stakeholders. The original US Preventive Services Task Force (USPSTF) LCS guidelines in 2013 were based on National Lung Screening Trial (NLST) inclusion criteria: patients 55 years or older with a heavy tobacco use history, consistent with the epidemiology of lung cancer in the 20th century. Importantly, about 90% of NLST participants were White. However, in the 21st century, the lung cancer epidemiology is changing, and LCS eligibility is not aligned with age and smoking histories in American Indian or Alaska Native, Asian, Black, and Hispanic/Latino persons with lung cancer. To address the observed mismatch between populations eligible for LCS and those who are ultimately diagnosed with incident disease, known as the eligible-incidence ratio (E-I ratio), the USPSTF issued updated LCS eligibility criteria in 2021, lowering both the minimum age and amount of tobacco use required. Although only 2 years have elapsed, multiple publications suggest that substantial access disparities will likely persist, with some of the largest obstacles facing groups with the highest risk of death from lung cancer, including Black people, those living in poverty, rural residents, veterans, and those living in states without expanded Medicaid coverage.
JAMA Oncology , éditorial, 2022