Abstract
ObjectiveLung cancer screening has been widely conducted in Western countries. However, population-based lung cancer screening programs in Hebei in China are sparse. Our study aimed to assess the participation rate and detection rate of positive nodules and lung cancer in Hebei province.MethodIn total, 228 891 eligible participants aged 40–74 years were enrolled in the Cancer Screening Program in Hebei from 2013 to 2019. A total of 54 846 participants were evaluated as the lung cancer high-risk population by a risk score system which basically followed the Harvard Risk Index and was adjusted for the characteristics of the Chinese population. Then this high-risk population was recommended for low-dose computed tomography (LDCT) screening. And all participants attended annual passive follow-up, and the active follow-up interval was based on radiologist’s suggestion. All participants were followed-up until December 31, 2020. The overall, group-specific participation rates were calculated, and its associated factors were analyzed by a multivariable logistic regression model. Participation rates and detection of positive nodules and lung cancer were reported.ResultsThe overall participation rate was 52.69%, where 28 899 participants undertook LDCT screening as recommended. The multivariable logistic regression model demonstrated that a high level of education, having disease history, and occupational exposure were found to be associated with the participation in LDCT screening. The median follow-up time was 3.56 person-years. Overall, the positive identification of lung nodules and suspected lung cancer were 12.73% and 1.46% through LDCT screening. After the native and passive follow-up, 257 lung cancer cases were diagnosed by lung cancer screening, and the detection rate of lung cancer was 0.89% in the screening group. And its incidence density was 298.72 per 100,000. Positive lung nodule rate and detection rate were increased with age.ConclusionOur study identified personal and epidemiological factors that could affect the participation rate. Our findings could provide the guideline for precise prevention and control of lung cancer in the future.
Highlights
Lung cancer is the second most diagnosed cancer, and it is the leading cause of cancer death in the world
We found that participants who had occupational exposure had 45% higher odds of undertaking screening than other participants (OR: 1.45; 95%confidence intervals (CIs): 1.39-1.51)
After adjusting for year of recruitment, study areas, married condition, Body Mass Index (BMI), drinking consumption, heating methods, and cooking fuels, we found that age, sex, educational level, occupation, occupational exposure, smoke condition, second-hand smoking exposure, history of lung diseases, and family history of lung cancer were associated with participation rate (Table 2)
Summary
Lung cancer is the second most diagnosed cancer, and it is the leading cause of cancer death in the world. As reported by the Chinese National Cancer Center (CNCC), with a 36.05/100,000 age-standardized incidence rate and a 28.06/100,000 age-standardized mortality rate, lung cancer was the most common cancer and the leading cause of cancer death in 2016 in China. It showed an increasing trend in China [2]. Lung cancer screening programs have been organized by many countries, such as the national lung cancer screening trial (NLST), National Cancer Institute Prostate, Lung, Colorectal & Ovarian Cancer Screening Trial (PLCO), and others [4, 8, 9]. The effectiveness evaluation of lung cancer screening programs in China, in which the lifestyle is different from Western countries, is still rare
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