Abstract
BackgroundThe US has recently lowered the entry age for lung cancer screening with low-dose computed tomography (LDCT) from 55 to 50 years. The effect of the younger age for starting screening on the rates of screen-detected and radiation-induced lung cancers in women remains unclear. MethodsA modeling study was conducted. A static cohort of 100,000 heavy female smokers was simulated to undergo annual lung cancer screening with LDCT. The number of screen-detected lung cancers (benefit) and radiation-induced lung cancers (harm) per 1000 screenees were calculated for scenarios with two starting ages (55–50 years) and fixed stopping age (75 years). The benefit-harm ratio and incremental benefit-harm ratio (IBHR) were calculated for each scenario. ResultsFor annual screening from 55 to 75 years, the number of screen-detected and radiation-induced lung cancers was 112.4 and 2.2, respectively. For annual screening from 50 to 75 years, those numbers were 117.0 and 3.4, respectively. The benefit-harm ratio decreased from 51 to 35 and the IBHR decreased from 6.3 to 4.0 when lowering the screening starting age from 55 to 50 years. ConclusionsThe risk of radiation induced lung cancers increased by 50% when lowering the screening starting age by 5 years in women. However, the benefits of LDCT lung cancer screening still outweigh the assumed radiation harm.
Highlights
Lung cancer screening by low-dose computed tomography (LDCT) is effective and cost-effective for reducing lung cancer mortality in smokers [1,2,3]
How ever, a trade-off was that the rate of radiation-induced lung cancers due to the implementation of screening increased from 1 for every 51 lung cancers detected by annual low-dose computed to mography (LDCT) screening at age 55 years to 1 for every 35 lung cancers detected at age 50 years
The incremental benefit-harm ratio (IBHR) compared to the starting age of 55 years indicated that starting screening 1–5 years earlier led to 6.3 to 4.0 additional lung cancers at the cost of one addi tional radiation-induced lung cancer due to annual LDCT screening
Summary
Lung cancer screening by low-dose computed tomography (LDCT) is effective and cost-effective for reducing lung cancer mortality in smokers [1,2,3]. In March 2021, the US Preventive Services Task Force (USPSTF) has broadened the eligibility by lowering the starting age of lung cancer screening from 55 to 50 years [7], based on extensive evidence including the fact that LDCT screening rarely causes radiation-induced cancer [8]. The effect of the younger age for starting screening on the rates of screendetected and radiation-induced lung cancers in women remains unclear. The number of screen-detected lung cancers (benefit) and radiation-induced lung cancers (harm) per 1000 screenees were calculated for scenarios with two starting ages (55–50 years) and fixed stopping age (75 years). Conclusions: The risk of radiation induced lung cancers increased by 50% when lowering the screening starting age by 5 years in women. The benefits of LDCT lung cancer screening still outweigh the assumed ra diation harm
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