Time to first cigarette and early detection in the National Lung Screening Trial

国家肺部筛查试验中首次吸烟的时间和早期发现

• 批准号: 9022934
• 负责人: JOSHUA E MUSCAT
• 金额: $ 7.74万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-12-23 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9022934
• 关键词: Accounting; Adult; Advisory Committees; Age; American; American Cancer Society; Behavior; Cancer Etiology; Carcinogen exposure; Carcinogens; Chest; Cigarette; Cigarette Smoker; Clinical Trials; Colorectal Cancer; Costs and Benefits; Data; Diagnosis; Dose; Early Diagnosis; Environment; Frequencies; Genetic; Goals; Hour; Individual; Lung; Lung Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Measures; Modeling; National Cancer Institute; Newly Diagnosed; Nicotine; Nicotine Dependence; Participant; Physicians; Preventive service; Progression-Free Survivals; Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; Radiation; Recommendation; Recording of previous events; Relative Risks; Research; Risk; Risk Assessment; Risk Factors; Screening for Ovarian Cancer; Smoke; Smoker; Smoking; Smoking History; Staging; Survival Rate; Target Populations; Testing; Thoracic Radiography; Thoracic Surgical Procedures; Time; Tobacco-Associated Carcinogen; Tobacco-Related Carcinoma; United States; X-Ray Computed Tomography; cancer risk; clinical risk; college; cost; high risk; improved; inclusion criteria; low-dose spiral CT; lung cancer screening; mortality; predictive modeling; public health relevance; randomized trial; screening; trend; tumor; uptake

 DESCRIPTION (provided by applicant): The National Lung Screening Trial (NLST) of 53,454 current and former healthy smokers demonstrated that low dose computed tomography (LDCT) was effective in detecting lung tumors at an earlier stage and increasing survival from lung cancer. Lung cancer is by far the leading cause of cancer mortality, with a 5-year survival rate of about 17%. 5-year survival rate is about 54% for localized tumors, indicating that LDCT could substantially reduce mortality rates among the estimated annual 224,000 newly diagnosed cases. In December 2013, the United States Preventive Services Task Force (USTSPF) recommended annual screening with LDCT to adult smokers between the ages of 55 and 80. The risks associated with LDCT include false positives, radiation exposure, and the costs of screening. To improve the benefit/cost ratio, the USPSTF and the National Cancer Institute acknowledge that there is a need to identify additional lung cancer risk factors to better characterize the high risk target populations that would benefit from LDCT screening. The current study proposes to study the effects of a nicotine dependence behavior, the time to first cigarette (TFFC) after waking, on the early detection of lung cancer and overall survival time in the NLST. Recently, an early TTFC (within 15 minutes) has been shown to double the risk of all major histological types of lung cancer compared to smokers who waited an hour or more for their first cigarette. The association is dose-dependent, with a trend toward increasing risk with an earlier TTFC. The findings were independently replicated in several large-scale studies. The doubling of risk is observed among smokers, after careful adjustment for smoking history using a variety of models of cigarette exposure history. The mechanism underlying the association between TTFC and lung cancer appears to reflect the intensity of smoking, a critical determinant of tobacco carcinogen exposure that is not accounted for by standard smoking exposure measures such as duration and frequency. The TTFC is an equal if not better predictor of nicotine and carcinogen uptake in smokers than cigarettes per day, which explains its association with lung cancer risk, as well as with the risk of other tobacco-related cancers. A 30-pack year history of smoking was the inclusion criteria for the NLST, and is currently recommended for annual screening for lung cancer with low-dose CT. The NLST has collected information on TTFC in a subset of its participants, but the effect of TTFC on early detection has not yet been evaluated.

 描述（由适用提供）：53,454名当前和前健康吸烟者的国家肺筛查试验（NLST）表明，低剂量计算机断层扫描（LDCT）在早期阶段检测到肺肿瘤有效，并增加了肺癌的生存率。到目前为止，肺癌是癌症死亡率的主要原因，其存活率为5年 约17％。局部肿瘤的5年生存率约为54％，表明LDCT可以大大降低估计的年度224,000例新诊断病例的死亡率。 2013年12月，美国预防服务工作组（USTSPF）建议通过LDCT对55至80岁的成年吸烟者进行年度筛查。与LDCT相关的风险包括误报，放射线曝光和筛查费用。为了提高收益/成本比率，USPSTF和国家癌症研究所承认，有必要确定额外的肺癌风险因素，以更好地表征将受益于LDCT筛查的高风险目标人群。当前的研究提案旨在研究尼古丁依赖行为的影响，醒来后首次香烟（TFFC）的时间对NLST的肺癌早期发现和总体生存时间。最近，与等待一小时或更长时间的第一批香烟的吸烟者相比，早期的TTFC（在15分钟内）被证明是所有主要组织学类型的肺癌类型的风险。该关联是依赖剂量的，其趋势趋于通过较早的TTFC增加风险。这些发现在几项大规模研究中独立复制。在使用各种民用暴露历史模型对吸烟史进行仔细调整后，在吸烟者中观察到了两倍的风险。 TTFC与肺癌之间关联的基础机制似乎反映了吸烟的强度，这是烟草致癌物暴露的关键确定剂，这不是由标准的吸烟暴露措施（例如持续时间和频率）所考虑的。 TTFC是吸烟者中尼古丁和致癌物吸收的预测指标，即与每天的香烟相比，这解释了其与肺癌风险的关联，以及其他与烟草有关的癌症的风险。吸烟的历史是30个包装的历史，是NLST的纳入标准，目前建议对低剂量CT进行肺癌的年度筛查。 NLST在其参与者的一部分中收集了有关TTFC的信息，但尚未评估TTFC对早期检测的影响。