Risk-adapted starting age of personalized lung cancer screening: a population-based, prospective cohort study in China

BACKGROUND:The current one-size-fits-all screening strategy for lung cancer is not suitable for personalized screening. RESEARCH QUESTION:What is the risk-adapted starting age of lung cancer screening with comprehensive consideration of risk factors? Study Deign and Methods: National Lung Cancer Screening programme, a multi-center, population-based, prospective cohort study was analyzed. Information on risk factor exposure was collected during the baseline risk assessment. Cox proportional hazards model was used to estimate the association between risk factors and lung cancer incidence. Age-specific 10-year cumulative risk was calculated to determine the age at which individuals with various risk factors reached the equivalent risk level as individuals who smoked aged 50 years with a ≥20 pack-year smoking history. RESULTS:Out of the 1,031,911 participants enrolled in this study, 3,908 developed lung cancer after a median follow-up of 3.8 years. We identified seven risk factors for lung cancer, including smoking pack-years, secondhand smoke, family history of lung cancer in first-degree relatives, history of respiratory diseases, occupational hazardous exposure, body mass index, and diabetes. The 10-year cumulative risk of lung cancer for persons who smoked aged 50 years with a history of smoking ≥20 pack-years was 1.37%, which was treated as the risk threshold for screening. Individuals who never smoked and those who smoked with a history of smoking <30 pack-years reached the equivalent risk level 1-14 years later compared with the starting age of 50 years. Males who smoked with a history of smoking ≥30 pack-years and concurrent respiratory diseases or diabetes should be screened one year earlier at the age of 49 years. INTERPRETATION:The personalized risk-adapted starting ages for lung cancer screening, based on the principle of "equal management of equal risk", can served as an optimized screening strategy to identify high-risk individuals.