Participation and Yield of a Lung Cancer Screening Program in Hebei, China

Abstract

ObjectiveLung cancer screening has been widely conducted in Western countries. However, population-based lung cancer screening programs in Hebei in China are sparse. Our study aimed to assess the participation rate and detection rate of positive nodules and lung cancer in Hebei province.MethodIn total, 228 891 eligible participants aged 40–74 years were enrolled in the Cancer Screening Program in Hebei from 2013 to 2019. A total of 54 846 participants were evaluated as the lung cancer high-risk population by a risk score system which basically followed the Harvard Risk Index and was adjusted for the characteristics of the Chinese population. Then this high-risk population was recommended for low-dose computed tomography (LDCT) screening. And all participants attended annual passive follow-up, and the active follow-up interval was based on radiologist’s suggestion. All participants were followed-up until December 31, 2020. The overall, group-specific participation rates were calculated, and its associated factors were analyzed by a multivariable logistic regression model. Participation rates and detection of positive nodules and lung cancer were reported.ResultsThe overall participation rate was 52.69%, where 28 899 participants undertook LDCT screening as recommended. The multivariable logistic regression model demonstrated that a high level of education, having disease history, and occupational exposure were found to be associated with the participation in LDCT screening. The median follow-up time was 3.56 person-years. Overall, the positive identification of lung nodules and suspected lung cancer were 12.73% and 1.46% through LDCT screening. After the native and passive follow-up, 257 lung cancer cases were diagnosed by lung cancer screening, and the detection rate of lung cancer was 0.89% in the screening group. And its incidence density was 298.72 per 100,000. Positive lung nodule rate and detection rate were increased with age.ConclusionOur study identified personal and epidemiological factors that could affect the participation rate. Our findings could provide the guideline for precise prevention and control of lung cancer in the future.

Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study

“…The LDCT screening participation rate for nonsmokers was higher than that for smokers, as reported in other studies [ 13 , 14 ]. Studies have consistently shown that smokers have lower recognition of tobacco harm, lower health awareness, or preferred not to be notified of their status of lung cancer [ 14 - 18 ]. Women accounted for the majority of nonsmokers, and women had better awareness of cancer prevention than men [ 19 ].…”

Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region

“… 46 , 47 In a Chinese LCS program that achieved a participation rate > 50%, people who had never smoked had higher education levels, a family history of lung cancer, and occupational exposure, and had higher rates of participation. 48 Male participants have also been over-represented in international trials, 49 and more evidence is needed about the optimal strategies to recruit female participants. A lack of centralized patient registration systems in most WPR countries precludes the systematic mailing of invitations, appointment reminders, and recalls after screening.…”

“…Australia and Japan have the greatest number of CT machines per capita. 48 However, many WPR countries have few CT machines and limited numbers of appropriately skilled thoracic radiologists and radiographers (Table 2 ). Thoracic surgeons, clinical oncologists, and specialist oncology nurses are essential to the delivery of a LCS program.…”

Contemporary Concise Review 2021: Pulmonary nodules from detection to intervention

“…16,17 Effective, high-quality programmes also require adherence to recommendations for follow-up investigations including recommended screening intervals. Summarized results of studies evaluating participation and adherence to follow-up are presented in Table 1, including data from screening populations in China 18 and the United States 19 as well as recommendations based on a British review of participation in clinical trials and pilot programmes. 20…”