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Lung Cancer Incidence and Mortality After Negative Low-Dose CT Imaging Screening Results
Huan Liu1, Shipeng Yan2, Pengcheng Liu1
1Department of Epidemiology and Biostatistics and Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
The clinical value of a negative low-dose CT (LDCT) screening results for long-term risk stratification remains unclear, leading to uncertainties in rescreening intervals.
Research Question:
What are the long-term risks of lung cancer incidence and mortality among individuals with negative screening results?
Study Design And Methods:
This prospective cohort study used data from provincial initiatives (2012-2019) within China's National Lung Cancer Screening Program. Participants 40 to 74 years of age were categorized as nonscreened, negative screening results, positive screening results, or low risk. Inverse probability weighting integrated with Cox proportional hazard models was used to estimate the hazard ratios (HRs) and 95% CIs for lung cancer incidence and mortality.
Results:
During a median follow-up of 8.61 years, 3,173 incident lung cancers and 2,083 lung cancer deaths occurred among 269,173 participants. Compared with the nonscreened group, the group with negative screening results exhibited a significantly lower risk of lung cancer incidence (HR, 0.80; 95% CI, 0.65-0.97) and all-cause mortality (HR, 0.77; 95% CI, 0.70-0.85), whereas lung cancer-specific mortality did not differ significantly (HR, 0.88; 95% CI, 0.69-1.12). The reduced risk of lung cancer persisted throughout follow-up and was most pronounced during the first 3 years. Although the group with negative screening results exhibited lung cancer incidence (HR, 0.84; 95% CI, 0.68-1.03), lung cancer mortality (HR, 0.89; 95% CI, 0.69-1.15), and all-cause mortality (HR, 0.91; 95% CI, 0.80-1.05) comparable with those in the low-risk group, a slightly lower risk of lung cancer was observed in the group with negative screening results at the 9-year cumulative follow-up. In stratified analyses, individuals who were currently smoking with negative screening results showed a higher long-term risk of lung cancer incidence than those in the low-risk group.
Interpretation:
Our results show that individuals with negative LDCT screening results generally had long-term risks of lung cancer incidence, mortality, and all-cause mortality comparable with those of the low-risk population, supporting risk-stratified follow-up, rather than uniform annual rescreening.