Evaluation of a Low-Dose Computed Tomography Lung Cancer Screening Program in Henan, China

This cross-sectional study assesses the participation and detection rates of a lung cancer screening program in China and the factors associated with participation and detection among individuals at high risk for lung cancer. Key PointsQuestionWhat were the participation rate and detection rate of lung cancer and the factors associated with participation in a population-based screening program in China? FindingsIn this cross-sectional study of 282377 participants including 55428 with high risk for lung cancer, adherence to low-dose computed tomography screening was 40.16%, and factors associated with the willingness to accept low-dose computed tomography screening included female sex, former smoking, lack of physical activity, and family history of lung cancer. MeaningThese findings may inform future evaluations of the effectiveness and cost-effectiveness of cancer screening programs in China. ImportanceLung cancer screening has been widely implemented in Europe and the US. However, there is little evidence on participation and diagnostic yields in population-based lung cancer screening in China. ObjectiveTo assess the participation rate and detection rate of lung cancer in a population-based screening program and the factors associated with participation. Design, Setting, and ParticipantsThis cross-sectional study used data from the Cancer Screening Program in Urban China from October 2013 to October 2019, with follow-up until March 10, 2020. The program is conducted at centers in 8 cities in Henan Province, China. Eligible participants were aged 40 to 74 and were evaluated for a high risk for lung cancer using an established risk score system. Main Outcomes and MeasuresOverall and group-specific participation rates by common factors, such as age, sex, and educational level, were calculated. Differences in participation rates between those groups were compared. The diagnostic yield of both screening and nonscreening groups was calculated. ResultsThe study recruited 282377 eligible participants and included 55428 with high risk for lung cancer; the mean (SD) age was 55.3 (8.1) years, and 34966 participants (63.1%) were men. A total of 22260 participants underwent LDCT (participation rate, 40.16%; 95% CI, 39.82%-40.50%). The multivariable logistic regression model showed that female sex (odds ratio [OR], 1.64; 95% CI, 1.52-1.78), former smoking (OR, 1.26; 95% CI, 1.13-1.41), lack of physical activity (OR, 1.19; 95% CI, 1.14-1.24), family history of lung cancer (OR, 1.73; 95% CI, 1.66-1.79), and 7 other factors were associated with increased participation of LDCT screening. Overall, at 6-year follow-up, 78 participants in the screening group (0.35%; 95% CI, 0.29%-0.42%) and 125 in the nonscreening group (0.38%; 95% CI, 0.33%-0.44%) had lung cancer detected, which resulted in an odds ratio of 0.93 (95% CI, 0.70-1.23; P=.61). Conclusions and RelevanceThe low participations rate in the program studied suggests that an improved strategy is needed. These findings may provide useful information for designing effective population-based lung cancer screening strategies in the future.