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https://www.arca.fiocruz.br/handle/icict/60895
LUNG CANCER SCREENING IN BRAZIL: A MODELING ANALYSIS COMPARING THE 2013 AND 2021 UNITED STATES PREVENTIVE SERVICES TASK FORCE (USPSTF) GUIDELINES
Calculadora de Risco
Rastreamento
Tomografia Computadorizada de Baixa Dose
Detecção em Estágios Iniciais
Alternative title
LCDRAT and LCRAT calculator applied to three risk criteria in the Brazilian populationAuthor
Affilliation
UMass Chan Medical School. Department of Surgery. Division of Thoracic Surgery. Massachusetts, United States.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Ciências Farmacêuticas. Macaé, RJ, Brasil.
Instituto Nacional de Câncer. Coordenação de Ensino. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Rio de Janeiro. Instituto de Ciências Farmacêuticas. Macaé, RJ, Brasil.
Instituto Nacional de Câncer. Coordenação de Ensino. Rio de Janeiro, RJ, Brasil.
Abstract
Abstract
Importance. In Brazil, from 2023 to 2025, it is estimated that lung cancer (LC) will be the second most frequent cancer, and the country does not have an LC Screening (LCS) policy.
Objective: To compare the number of individuals eligible for screening, 5-year preventable LC-deaths, and years of life gained (YLG) if LC-death is averted due to LCS, considering three eligibility strategies by sociodemographic characteristics.
Design: Comparative Effectiveness Research, assessing three LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Setting: 2019 Brazilian National Household Survey (BNHS).
Participants: ever-smokers aged 50-80 years.
Intervention: a) ever-smokers aged 50-80 years; US-Preventive-Services-Task-Force (USPSTF-2013): ever-smokers aged 55-80 years with 30 or more pack-years and less than 15 years since cessation and c) USPSTF-2021: ever-smokers ages 50-80 years with 20-pack-year, and less than 15 years since cessation.
Primary Outcome(s): individuals eligible for screening, 5-year preventable LC-deaths, and years of life gained (YLG) if LC-death is averted due to screening.
Results: In Brazil, the eligible population for LCS was, respectively, 27,280,920 when considering ever-smokers aged 50-80 years (49.1% female, 48.6% 50-60 years-old, 47% white,45.6% with incomplete middle school and 47.1% living at the Southeast region); 5,144,322 individuals as per USPSTF-2013 criteria (40.6% female, 44.5% 61-70 years-old, 48.8% white, 47.4% with incomplete middle school and 50% living at the Southeast region); and 8,380,279 for USPSTF-2021 (41.9% female, 51.9% 50-60 years-old, 48.8% white, 48% with incomplete middle school and 49.7% living at the Southeast region). In the USPSTF-2013 criteria, the number needed to screen (NNS) was 177 individuals to prevent one death, while following USPSTF-2021, it was 242. For ever-smokers, the YLG was 23, 19 for USPSTF-2013 and 21 for USPSTF-2021. Being Black, having less than a high school education, and living in North and Northeast regions increases the 5-year risk of LC-death. Conclusions In this comparative effectiveness study, USPSTF-2021 criteria were better than USPSTF-2013 on reducing disparities. Nonetheless, the risk of LC death remained unequal. Our results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.
Keywords in Portuguese
Câncer de PulmãoCalculadora de Risco
Rastreamento
Tomografia Computadorizada de Baixa Dose
Detecção em Estágios Iniciais
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