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肺がんのスクリーニング:米国の予防サービスタスクフォースの勧告声明
, Alex H Krist1,2, Karina W Davidson3
1Fairfax Family Practice Residency, Fairfax, Virginia.
JAMA
|March 9, 2021
まとめ
50歳から80歳までの高リスク成人の場合,低用量CTスキャンによる年間肺がんスクリーニングが推奨されます. このスクリーニングは,喫煙歴のある個人に早期発見のための適度な純利益を提供します.
科学分野:
- 肺内科
- 腫瘍学
- 予防 医療
背景:
- 肺がんは米国で がんによる死亡の主な原因で 喫煙が主な危険因子です
- 早期の肺がんは 進行した病気よりも 予後が良く 治療が容易です
- 米国予防サービスタスクフォース (USPSTF) は以前,2013年に勧告を更新しました.
研究 の 目的:
- 肺がんのスクリーニングに関する2013年USPSTFの勧告を更新する.
- 低用量コンピュータトモグラフィー (LDCT) スクリーニングの精度,利益,害を評価する.
- モデル化研究を用いて最適なスクリーニング年齢,間隔,戦略を決定する.
主な方法:
- LDCTのスクリーニングの精度,利益,害について体系的なレビューが行われました.
- スクリーニングパラメータに関する意思決定を基にした共同モデリング研究です.
- 研究対象は,喫煙歴20パック年 (現在または過去15年以内の喫煙者) の50~80歳の成人でした.
主要な成果:
- 毎年実施されるLDCTのスクリーニングは,高リスクの個人に適度な純利益をもたらします.
- リスク評価には,年齢,喫煙歴 (パック年数),禁煙以来の時間なども含まれます.
- USPSTFはスクリーニングの利点について,適度な確信を持って結論付けました.
結論:
- USPSTFは20パック年喫煙歴のある50歳から80歳の成人のためのLDCTによる年次肺がんスクリーニングを推奨しています.
- 喫煙をやめて15年経った場合や 寿命を制限する病気や 手術の選択肢がある場合 スクリーニングは中止すべきです
- この更新された勧告は,2013年のガイドラインと比較して,開始年齢とパック年の値を下げています.
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