Abstract
More than half of males in China are current smokers and evidence from western countries tells us that an unprecedented number of smoking-attributable deaths will occur as the Chinese population ages. We used the China Lung Cancer Policy Model (LCPM) to simulate effects of computed tomography (CT)-based lung cancer screening in China, comparing the impact of a screening guideline published in 2015 by a Chinese expert group to a version developed for the United States by the U.S. Centers for Medicare & Medicaid Services (CMS). The China LCPM, built using an existing lung cancer microsimulation model, can project population outcomes associated with interventions for smoking-related diseases. After calibrating the model to published Chinese smoking prevalence and lung cancer mortality rates, we simulated screening from 2016 to 2050 based on eligibility criteria from the CMS and Chinese guidelines, which differ by age to begin and end screening, pack-years smoked, and years since quitting. Outcomes included number of screens, mortality reduction, and life-years saved for each strategy. We projected that in the absence of screening, 14.98 million lung cancer deaths would occur between 2016 and 2050. Screening with the CMS guideline would prevent 0.72 million deaths and 5.8 million life-years lost, resulting in 6.58% and 1.97% mortality reduction in males and females, respectively. Screening with the Chinese guideline would prevent 0.74 million deaths and 6.6 million life-years lost, resulting in 6.30% and 2.79% mortality reduction in males and females, respectively. Through 2050, 1.43 billion screens would be required using the Chinese screening strategy, compared to 988 million screens using the CMS guideline. In conclusion, CT-based lung cancer screening implemented in 2016 and based on the Chinese screening guideline would prevent about 20,000 (2.9%) more lung cancer deaths through 2050, but would require about 445 million (44.7%) more screens than the CMS guideline.
Highlights
China is the largest consumer of tobacco in the world, with over 300 million current smokers. [1] This figure is mainly driven by adult males: over half of Chinese men are estimated to be current smokers, compared to under 3% of women.[1]
Smoking prevalence in China has been slowly declining, the male smoking prevalence remains above 50% and is projected to be over 40% in the year 2050.[2]. The age-adjusted relative risk of death is significantly higher for smokers than for lifelong non-smokers, even among smokers with very few packyears.[3]
Lung cancer screening with computed tomography (CT) for current and former heavy smokers was estimated to result in a 20% mortality reduction among screened individuals compared to chest x-ray in the National Lung Screening Trial.[7]
Summary
China is the largest consumer of tobacco in the world, with over 300 million current smokers. [1] This figure is mainly driven by adult males: over half of Chinese men are estimated to be current smokers, compared to under 3% of women.[1]. [1] This figure is mainly driven by adult males: over half of Chinese men are estimated to be current smokers, compared to under 3% of women.[1] smoking prevalence in China has been slowly declining, the male smoking prevalence remains above 50% and is projected to be over 40% in the year 2050.[2] The age-adjusted relative risk of death is significantly higher for smokers than for lifelong non-smokers, even among smokers with very few packyears (a measure that incorporates both cigarette packs smoked per day and years of being a smoker—i.e. one pack-year is equal to one pack of cigarettes smoked per day for one year, or 0.5 packs of cigarettes per day for 2 years, etc.).[3] Among males in China, lung cancer has the highest incidence rate of all major cancers and among females it is second only to breast cancer.[4, 5] According to data from the World Health Organization, an estimated 422,000 males and 175,000 females in China died of lung cancer in 2012 alone.[6] The Chinese population’s demonstrated high smoking prevalence will inevitably result in millions of smoking-attributable deaths in the coming decades, many of which will be caused by lung cancer.[2]. These findings led to recommendations in 2015 from the U.S Centers for Medicare & Medicaid Services (CMS) that all current and former smokers ages 55–77 with a smoking history of at least 30 pack-years and no more than 15 years since quitting be screened for lung cancer with CT annually.[8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
