美国国家肺部筛查试验 (NLST) 和荷兰-比利时 NELSON 随机对照试验表明，低剂量计算机断层扫描 (CT) 肺癌筛查 (LCS) 可显着降低死亡率。 NLST、ITALUNG 和 COSMOS 试验为 LCS.LCS 试验死亡率获益结果、器官剂量和有效剂量数据以及电离辐射的生物效应、报告 VII (BEIR VII) 器官剂量与癌症死亡率风险提供了详细的剂量测定数据数据用于估计 NLST、ITALUNG 和 COSMOS 试验的获益与辐射风险比。这些试验的数据还用于估计与美国预防服务工作组和美国癌症协会推荐的方案相对应的长期 LCS 的获益与辐射风险比。仅包括筛查剂量、NLST 获益与辐射- 男性风险比为 12:1，女性风险比为 19:1，总体风险比为 16:1。包括筛查和估计的随访剂量，NLST 的获益与辐射风险比男性为 9:1，女性为 13:1，总体为 12:1。对于 ITALUNG 试验，获益与辐射风险之比为 58-63:1。对于 COSMOS 试验，假设像 NELSON 试验那样具有特定性别的死亡率获益，则获益与辐射风险之比为 23:1。假设保守的 20% 死亡率获益，对有 20 包年吸烟史的 50-79 岁人群进行年度筛查，获益与辐射风险之比为 23:1（后续剂量使筛查增加 40%）根据 COSMOS 剂量数据，将剂量）调整为 29:1（后续增加 10%）。基于线性、无阈值 BEIR VII 剂量风险估计，LCS 的获益与辐射风险比非常有利。结果强调了使用现代 CT 技术、保持低诊断随访率以及最大限度地减少筛查和诊断随访剂量的重要性。肺癌筛查的好处明显超过了对筛查和诊断期间暴露于辐射相关的未来危害的估计后续检查。我们的研究结果强调了使用最先进的计算机断层扫描仪和专门的低剂量肺部筛查和诊断随访技术进行肺癌筛查实践的重要性。© 2023 作者。 《癌症》由 Wiley periodicals LLC 代表美国癌症协会出版。

The US National Lung Screening Trial (NLST) and Dutch-Belgian NELSON randomized controlled trials have shown significant mortality reductions from low-dose computed tomography (CT) lung cancer screening (LCS). NLST, ITALUNG, and COSMOS trials have provided detailed dosimetry data for LCS.LCS trial mortality benefit results, organ dose and effective dose data, and Biological Effects of Ionizing Radiation, Report VII (BEIR VII) organ dose-to-cancer-mortality risk data are used to estimate benefit-to-radiation-risk ratios of the NLST, ITALUNG, and COSMOS trials. Data from those trials also are used to estimate benefit-to-radiation-risk ratios for longer-term LCS corresponding to scenarios recommended by United States Preventive Services Task Force and the American Cancer Society.Including only screening doses, NLST benefit-to-radiation-risk ratios are 12:1 for males, 19:1 for females, and 16:1 overall. Including both screening and estimated follow-up doses, benefit-to-radiation-risk ratios for NLST are 9:1 for males, 13:1 for females, and 12:1 overall. For the ITALUNG trial, the benefit-to-radiation-risk ratio is 58-63:1. For the COSMOS trial, assuming sex-specific mortality benefits like those of the NELSON trial, the benefit-to-radiation-risk ratio is 23:1. Assuming a conservative 20% mortality benefit, annual screening in people 50-79 years old with a 20+ pack-year history of smoking has benefit-to-radiation-risk ratios of 23:1 (with follow-up doses adding 40% to screening doses) to 29:1 (with follow-up adding 10%) based on COSMOS dose data.Based on linear, no threshold BEIR VII dose-risk estimates, benefit-to-radiation-risk ratios for LCS are highly favorable. Results emphasize the importance of using modern CT technologies, maintaining low diagnostic follow-up rates, and minimizing both screening and diagnostic follow-up doses.The benefits of lung cancer screening significantly outweigh estimates of future harms associated with exposure to radiation during screening and diagnostic follow-up examinations. Our findings emphasize the importance of lung cancer screening practices using state-of-the-art computed tomography scanners and specialized low-dose lung screening and diagnostic follow-up techniques.© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.