Risk-Adapted Starting Age of Personalized Lung Cancer Screening A Population-Based, Prospective Cohort Study in China

BACKGROUND: The current one-size-fits fi ts-all screening strategy for lung cancer is not suitable for personalized screening. RESEARCH QUESTION: What is the risk-adapted starting age of lung cancer screening with comprehensive consideration of risk factors? STUDY DESIGN AND METHODS: The National Lung Cancer Screening program, a multicenter, population-based, prospective cohort study, was analyzed. Information on risk factor exposure was collected during the baseline risk assessment. A Cox proportional hazards model was used to estimate the association between risk factors and lung cancer incidence. Age-specific fi c 10-year cumulative risk was calculated to determine the age at which individuals with various risk factors reached the equivalent risk level as individuals aged >= 50 years with active tobacco use and a >= 20 pack-year smoking history. RESULTS: Of the 1,031,911 participants enrolled in this study, 3,908 demonstrated lung cancer after a median follow-up of 3.8 years. We identified fi ed seven risk factors for lung cancer, including pack-years of smoking, secondhand smoke exposure, family history of lung cancer in fi rst-degree relatives, history of respiratory diseases, occupational hazardous exposure, BMI, and diabetes. The 10-year cumulative risk of lung cancer for people aged >= 50 years with active tobacco use and a >= 20 pack-year smoking history was 1.37%, which was treated as the risk threshold for screening. Individuals who never smoked and those with active tobacco use and a < 30-pack-year history of smoking reached the equivalent risk level 1 to 14 years later compared with the starting age of 50 years. Men with active tobacco use, a >= 30- pack-year history of smoking, and concurrent respiratory diseases or diabetes should be screened 1 year earlier at the age of 49 years. INTERPRETATION: The personalized risk-adapted starting ages for lung cancer screening, based on the principle of equal management of equal risk, can served as an optimized screening strategy to identify high-risk individuals.