• Chenran Wang, Xuesi Dong, Fengwei Tan, Zheng Wu, Yufei Huang, Yadi Zheng, Zilin Luo, Yongjie Xu, Liang Zhao, Jibin Li, Kaiyong Zou, Wei Cao, Fei Wang, Jiansong Ren, Jufang Shi, Wanqing Chen, Jie He, and Ni Li.
• Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing.
• Chest. 2024 Jun 1; 165 (6): 153815541538-1554.

BackgroundThe current one-size-fits-all screening strategy for lung cancer is not suitable for personalized screening.Research QuestionWhat is the risk-adapted starting age of lung cancer screening with comprehensive consideration of risk factors?Study Design And MethodsThe National Lung Cancer Screening program, a multicenter, population-based, prospective cohort study, was analyzed. Information on risk factor exposure was collected during the baseline risk assessment. A 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 aged ≥ 50 years with active tobacco use and a ≥ 20 pack-year smoking history.ResultsOf the 1,031,911 participants enrolled in this study, 3,908 demonstrated lung cancer after a median follow-up of 3.8 years. We identified seven risk factors for lung cancer, including pack-years of smoking, secondhand smoke exposure, family history of lung cancer in first-degree relatives, history of respiratory diseases, occupational hazardous exposure, BMI, and diabetes. The 10-year cumulative risk of lung cancer for people aged ≥ 50 years with active tobacco use and a ≥ 20 pack-year smoking history was 1.37%, which was treated as the risk threshold for screening. Individuals who never smoked and those with active tobacco use and a < 30-pack-year history of smoking reached the equivalent risk level 1 to 14 years later compared with the starting age of 50 years. Men with active tobacco use, a ≥ 30-pack-year history of smoking, and concurrent respiratory diseases or diabetes should be screened 1 year earlier at the age of 49 years.InterpretationThe 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.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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