Current US lung cancer screening recommendations limit eligibility to adults with a pack-year (PY) history of ≥20 years and the first 15 years since quit (YSQ). The authors conducted a systematic review to better understand lung cancer incidence, risk and mortality among otherwise eligible individuals in this population beyond 15 YSQ. The PubMed and Scopus databases were searched through February 14, 2023, and relevant articles were searched by hand. Included studies examined the relationship between adults with both a ≥20-PY history and ≥15 YSQ and lung cancer diagnosis, mortality, and screening ineligibility. One investigator abstracted data and a second confirmed. Two investigators independently assessed study quality and certainty of evidence (COE) and resolved discordance through consensus. From 2636 titles, 22 studies in 26 articles were included. Three studies provided low COE of elevated lung cancer incidence beyond 15 YSQ, as compared with people who never smoked, and six studies provided moderate COE that the risk of a lung cancer diagnosis after 15 YSQ declines gradually, but with no clinically significant difference just before and after 15 YSQ. Studies examining lung cancer-related disparities suggest that outcomes after 15 YSQ were similar between African American/Black and White participants; increasing YSQ would expand eligibility for African American/Black individuals, but for a significantly larger proportion of White individuals. The authors observed that the risk of lung cancer not only persists beyond 15 YSQ but that, compared with individuals who never smoked, the risk may remain significantly elevated for 2 or 3 decades. Future research of nationally representative samples with consistent reporting across studies is needed, as are better data from which to examine the effects on health disparities across different populations.

中文翻译：

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具有 20 年以上戒烟史的个体戒烟后 15 年以上的肺癌诊断和死亡率：系统评价

目前美国肺癌筛查建议将资格限制为年包年 (PY) 病史≥20 年且戒烟后前 15 年 (YSQ) 的成年人。作者进行了系统评价，以更好地了解 YSQ 超过 15 的人群中其他符合条件的个体的肺癌发病率、风险和死亡率。PubMed 和 Scopus 数据库检索截止日期为 2023 年 2 月 14 日，相关文章均为手工检索。纳入的研究考察了≥20-PY病史和≥15 YSQ的成年人与肺癌诊断、死亡率和筛查不合格之间的关系。一名研究人员提取了数据，另一名研究人员进行了确认。两名研究者独立评估研究质量和证据确定性 (COE)，并通过共识解决不一致的问题。从 2636 个标题中，纳入了 26 篇文章中的 22 项研究。三项研究提供了与从不吸烟的人相比，超过 15 个 YSQ 后肺癌发病率升高的低 COE，六项研究提供了中度 COE，表明 15 YSQ 后肺癌诊断风险逐渐下降，但与之前没有临床显着差异以及 15 YSQ 之后。检查肺癌相关差异的研究表明，非裔美国人/黑人和白人参与者在 15 个 YSQ 后的结果相似；提高 YSQ 将扩大非裔美国人/黑人的资格，但白人的比例要大得多。作者观察到，肺癌风险不仅持续超过 15 YSQ，而且与从不吸烟的人相比，该风险可能在 2 到 3 年内仍显着升高。未来需要对具有全国代表性的样本进行研究，并在研究之间提供一致的报告，也需要更好的数据来检查对不同人群健康差异的影响。