Ji, Guiyi

Background Analysis of the real-world data of low-dose spiral CT screening of healthy physical examination population in Southwest China from 2006 to 2017, discussed the standard of low-dose spiral CT screening for high-risk population of lung cancer in China. Methods Incorporate all team subjects who have undergone LDCT screenings at the Health Management Center of West China Hospital of Sichuan University between 2006 and 2017, and analyze the cumulative incidence and age-standardized (Segi population) incidence of lung cancer in the whole population; finally, analysis the age-specific, smoking and non-smokers’ lung cancer incidence. Results A total of 15,996 people who met the enrollment conditions and participated in the LDCT lung cancer screening were included. The average screening interval was 1.12±0.26 years, and the average follow-up time was 5.43±0.82 years; The cumulative number of lung cancer cases with negative baseline screening was 56 cases, and the cumulative incidence rate of lung cancer was 122.1/100,000 (the world standard rate is 60.6/100,000), of which males were 100.0/100,000 (the world standard rate is 45.3/100,000) and women were 156.6 /100,000 (the world standard rate is 94.7/100,000); the cumulative incidence of lung cancer in the smoking group is higher than that in the non-smoking group for both males and females, but the cumulative incidence of lung cancer in the non-smokers of the female population (146.3/100,000) is higher than that of the male population (86.5/10 Million). Conclusion In the real world study of lung cancer screening in Chinese population, we should consider setting different standards for high-risk groups of lung cancer by gender or smoking and non-smokers.

Abstract Background: Despite much research published on lung cancer screening, China has had no large-scale study on the missed diagnosis of lung cancer in physical examination population. We therefore did a real-world study using the current lung cancer screening guidelines to the physical examination population in China to determine the proportion of lung cancer cases that have been missed.Methods: A real-world prospective cohort study of screening, with the use of low-dose computed tomography, was conducted among people who took yearly health checkup in health management center of West China Hospital between 2006 and 2017. We respectively used current guidelines including lung cancer screening guidelines of the U.S. Preventive Services Task Force (USPSTF) and expert consensus on low dose spiral CT lung cancer screening in China. Results: In a total of 15996 participants with physical examination who completed the baseline screening, 6779 (42.4%) subjects had at least one positive finding, and 142 (2.1%) cases of lung cancer were screened positive. The false positive rate was 97.9%. Of 142 lung cancer cases detected in our study, only 9.2% met the lung cancer screening guidelines proposed by the USPSTF, and 24.4% met that of China. The rates of missed diagnosis were as high as 90.8% and 75.6% respectively. In addition, we did an in-depth analysis by gender. We found that among male lung cancer patients, the proportion of smokers was 75%, and the proportion of young people under 50 was 23.2%. Among female patients with lung cancer, the proportion of smokers was only 5.8%, and the proportion of young people under 50 was up to 33.3%.Conclusions: The rate of missed diagnosis was as high as 90.8% applying the current lung cancer screening guidelines to the physical examination population in China. Further study to determine screening guidelines for targeted populations, is warranted.