Charles Faselis1,2,3, Joel A Nations1,3, Charity J Morgan1,4, Jared Antevil1,3, Jeffrey M Roseman5, Sijian Zhang1, Gregg C Fonarow6, Helen M Sheriff1,2, Gregory D Trachiotis1,7,8, Richard M Allman2,9, Prakash Deedwania1,10, Qing Zeng-Trietler1,2, Daniel D Taub1, Amiya A Ahmed11, George Howard4, Ali Ahmed1,2,12. 1. Veterans Affairs Medical Center, Washington, DC. 2. Department of Medicine, School of Medicine, George Washington University, Washington, DC. 3. Department of Medicine, School of Medicine, Uniformed Services University, Washington, DC. 4. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham. 5. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham. 6. Department of Medicine, School of Medicine, University of California, Los Angeles, Los Angeles. 7. Department of Surgery, School of Medicine, George Washington University, Washington, DC. 8. Department of Biomedical Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC. 9. Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham. 10. Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco. 11. Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut. 12. Department of Medicine, School of Medicine, Georgetown University, Washington, DC.
Abstract
Importance: The US Preventive Services Task Force does not recommend annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who are former smokers with 20 or more pack-years of smoking who quit 15 or more years ago or current smokers with less than 20 pack-years of smoking. Objective: To determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended. Design, Settings, and Participants: This cohort study used the Cardiovascular Health Study (CHS) data sets obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS enrolled 5888 community-dwelling individuals aged 65 years and older in the US from June 1989 to June 1993 and collected extensive baseline data on smoking history. The current analysis was restricted to 4279 individuals free of cancer who had baseline data on pack-year smoking history and duration of smoking cessation. The current analysis was conducted from January 7, 2022, to May 25, 2022. Exposures: Current and prior tobacco use. Main Outcomes and Measures: Incident lung cancer during a median (IQR) of 13.3 (7.9-18.8) years of follow-up (range, 0 to 22.6) through December 31, 2011. A Fine-Gray subdistribution hazard model was used to estimate incidence of lung cancer in the presence of competing risk of death. Cox cause-specific hazard regression models were used to estimate hazard ratios (HRs) and 95% CIs for incident lung cancer. Results: There were 4279 CHS participants (mean [SD] age, 72.8 [5.6] years; 2450 [57.3%] women; 663 [15.5%] African American, 3585 [83.8%] White, and 31 [0.7%] of other race or ethnicity) included in the current analysis. Among the 861 nonheavy smokers (<20 pack-years), the median (IQR) pack-year smoking history was 7.6 (3.3-13.5) pack-years for the 615 former smokers with 15 or more years of smoking cessation, 10.0 (5.3-14.9) pack-years for the 146 former smokers with less than 15 years of smoking cessation, and 11.4 (7.3-14.4) pack-years for the 100 current smokers. Among the 1445 heavy smokers (20 or more pack-years), the median (IQR) pack-year smoking history was 34.8 (26.3-48.0) pack-years for the 516 former smokers with 15 or more years of smoking cessation, 48.0 (35.0-70.0) pack-years for the 497 former smokers with less than 15 years of smoking cessation, and 48.8 (31.6-57.0) pack-years for the 432 current smokers. Incident lung cancer occurred in 10 of 1973 never smokers (0.5%), 5 of 100 current smokers with less than 20 pack-years of smoking (5.0%), and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5.0%). Compared with never smokers, cause-specific HRs for incident lung cancer in the 2 groups for whom LDCT is not recommended were 10.54 (95% CI, 3.60-30.83) for the current nonheavy smokers and 11.19 (95% CI, 5.40-23.21) for the former smokers with 15 or more years of smoking cessation; age, sex, and race-adjusted HRs were 10.06 (95% CI, 3.41-29.70) for the current nonheavy smokers and 10.22 (4.86-21.50) for the former smokers with 15 or more years of smoking cessation compared with never smokers. Conclusions and Relevance: The findings of this cohort study suggest that there is a high risk of lung cancer among smokers for whom LDCT screening is not recommended, suggesting that prediction models are needed to identify high-risk subsets of these smokers for screening.
Importance: The US Preventive Services Task Force does not recommend annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who are former smokers with 20 or more pack-years of smoking who quit 15 or more years ago or current smokers with less than 20 pack-years of smoking. Objective: To determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended. Design, Settings, and Participants: This cohort study used the Cardiovascular Health Study (CHS) data sets obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS enrolled 5888 community-dwelling individuals aged 65 years and older in the US from June 1989 to June 1993 and collected extensive baseline data on smoking history. The current analysis was restricted to 4279 individuals free of cancer who had baseline data on pack-year smoking history and duration of smoking cessation. The current analysis was conducted from January 7, 2022, to May 25, 2022. Exposures: Current and prior tobacco use. Main Outcomes and Measures: Incident lung cancer during a median (IQR) of 13.3 (7.9-18.8) years of follow-up (range, 0 to 22.6) through December 31, 2011. A Fine-Gray subdistribution hazard model was used to estimate incidence of lung cancer in the presence of competing risk of death. Cox cause-specific hazard regression models were used to estimate hazard ratios (HRs) and 95% CIs for incident lung cancer. Results: There were 4279 CHS participants (mean [SD] age, 72.8 [5.6] years; 2450 [57.3%] women; 663 [15.5%] African American, 3585 [83.8%] White, and 31 [0.7%] of other race or ethnicity) included in the current analysis. Among the 861 nonheavy smokers (<20 pack-years), the median (IQR) pack-year smoking history was 7.6 (3.3-13.5) pack-years for the 615 former smokers with 15 or more years of smoking cessation, 10.0 (5.3-14.9) pack-years for the 146 former smokers with less than 15 years of smoking cessation, and 11.4 (7.3-14.4) pack-years for the 100 current smokers. Among the 1445 heavy smokers (20 or more pack-years), the median (IQR) pack-year smoking history was 34.8 (26.3-48.0) pack-years for the 516 former smokers with 15 or more years of smoking cessation, 48.0 (35.0-70.0) pack-years for the 497 former smokers with less than 15 years of smoking cessation, and 48.8 (31.6-57.0) pack-years for the 432 current smokers. Incident lung cancer occurred in 10 of 1973 never smokers (0.5%), 5 of 100 current smokers with less than 20 pack-years of smoking (5.0%), and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5.0%). Compared with never smokers, cause-specific HRs for incident lung cancer in the 2 groups for whom LDCT is not recommended were 10.54 (95% CI, 3.60-30.83) for the current nonheavy smokers and 11.19 (95% CI, 5.40-23.21) for the former smokers with 15 or more years of smoking cessation; age, sex, and race-adjusted HRs were 10.06 (95% CI, 3.41-29.70) for the current nonheavy smokers and 10.22 (4.86-21.50) for the former smokers with 15 or more years of smoking cessation compared with never smokers. Conclusions and Relevance: The findings of this cohort study suggest that there is a high risk of lung cancer among smokers for whom LDCT screening is not recommended, suggesting that prediction models are needed to identify high-risk subsets of these smokers for screening.
Authors: Amiya A Ahmed; Kanan Patel; Margaret A Nyaku; Raya E Kheirbek; Vera Bittner; Gregg C Fonarow; Gerasimos S Filippatos; Charity J Morgan; Inmaculada B Aban; Marjan Mujib; Ravi V Desai; Richard M Allman; Michel White; Prakash Deedwania; George Howard; Robert O Bonow; Ross D Fletcher; Wilbert S Aronow; Ali Ahmed Journal: Circ Heart Fail Date: 2015-06-02 Impact factor: 8.790
Authors: L P Fried; N O Borhani; P Enright; C D Furberg; J M Gardin; R A Kronmal; L H Kuller; T A Manolio; M B Mittelmark; A Newman Journal: Ann Epidemiol Date: 1991-02 Impact factor: 3.797
Authors: Harry J de Koning; Carlijn M van der Aalst; Pim A de Jong; Ernst T Scholten; Kristiaan Nackaerts; Marjolein A Heuvelmans; Jan-Willem J Lammers; Carla Weenink; Uraujh Yousaf-Khan; Nanda Horeweg; Susan van 't Westeinde; Mathias Prokop; Willem P Mali; Firdaus A A Mohamed Hoesein; Peter M A van Ooijen; Joachim G J V Aerts; Michael A den Bakker; Erik Thunnissen; Johny Verschakelen; Rozemarijn Vliegenthart; Joan E Walter; Kevin Ten Haaf; Harry J M Groen; Matthijs Oudkerk Journal: N Engl J Med Date: 2020-01-29 Impact factor: 91.245
Authors: Philippe Meyer; Gerasimos S Filippatos; Mustafa I Ahmed; Ami E Iskandrian; Vera Bittner; Gilbert J Perry; Michel White; Inmaculada B Aban; Marjan Mujib; Louis J Dell'Italia; Ali Ahmed Journal: Circulation Date: 2010-01-04 Impact factor: 29.690
Authors: Harry J de Koning; Rafael Meza; Sylvia K Plevritis; Kevin ten Haaf; Vidit N Munshi; Jihyoun Jeon; Saadet Ayca Erdogan; Chung Yin Kong; Summer S Han; Joost van Rosmalen; Sung Eun Choi; Paul F Pinsky; Amy Berrington de Gonzalez; Christine D Berg; William C Black; Martin C Tammemägi; William D Hazelton; Eric J Feuer; Pamela M McMahon Journal: Ann Intern Med Date: 2014-03-04 Impact factor: 25.391
Authors: Alex H Krist; Karina W Davidson; Carol M Mangione; Michael J Barry; Michael Cabana; Aaron B Caughey; Esa M Davis; Katrina E Donahue; Chyke A Doubeni; Martha Kubik; C Seth Landefeld; Li Li; Gbenga Ogedegbe; Douglas K Owens; Lori Pbert; Michael Silverstein; James Stevermer; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2021-03-09 Impact factor: 56.272
Authors: Rafael Meza; Jihyoun Jeon; Iakovos Toumazis; Kevin Ten Haaf; Pianpian Cao; Mehrad Bastani; Summer S Han; Erik F Blom; Daniel E Jonas; Eric J Feuer; Sylvia K Plevritis; Harry J de Koning; Chung Yin Kong Journal: JAMA Date: 2021-03-09 Impact factor: 157.335