2021 年，美国预防服务工作组扩大了肺部筛查建议范围，将年龄在 50-80 岁、曾经吸烟、吸烟至少 20 包年且戒烟时间不到 15 年的人纳入其中 (YSQ)。然而，研究表明，对以前吸烟且 YSQ 较长的人进行筛查可能是有益的。作者使用两种经过验证的肺癌模型来评估使用不同 YSQ 阈值（10、15、20、25、30 和没有 YSQ）以及停止筛查的年龄。还评估了仅在进入时而非退出时强制执行 YSQ 标准的影响。结果包括筛查次数、筛查百分比、筛查益处（避免肺癌死亡、延长生命年）和危害（假阳性检测、过度诊断病例、辐射引起的肺癌死亡）。进行了敏感性分析，以评估将筛查限制在预期寿命至少为 5 年的人群中的效果。随着 YSQ 标准的放宽，筛查的数量以及筛查的利弊增加。正如预期的那样，提高停止筛查年龄会带来额外的好处，但也会导致更多的过度诊断，因为 80 岁以上人群的筛查增加。将筛查范围限制在预期寿命至少为 5 年的人群中，将保持大部分益处，同时大大减少危害。将筛查范围扩大到以前吸烟且 YSQ 超过 15 的人群，将导致避免的死亡人数和生命年大幅增加获得了。尽管会发生额外的伤害，但可以通过确保筛查仅限于那些具有合理预期寿命的人来减轻这些伤害。© 2023 作者。 《癌症》由 Wiley periodicals LLC 代表美国癌症协会出版。

In 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50-80 years who had ever smoked and had at least 20 pack-years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.The authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life-years gained), and harms (false-positive tests, overdiagnosed cases, radiation-induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy.As the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms.Expanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life-years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.