OBJECTIVES The degree of overdiagnosis due to lung cancer screening in the general US population remains unknown. Estimates may be influenced by the method used and by decreasing smoking trends, which reduce lung cancer risk and screening eligibility over time. Therefore, we aimed to estimate the degree of overdiagnosis due to lung cancer screening in the general US population, using three distinct methods. MATERIAL AND METHODS The MISCAN-Lung model was used to project lung cancer incidence and overdiagnosis in the general US population between 2018-2040, assuming perfect adherence to the United States Preventive Task Force recommendations. MISCAN-Lung was calibrated to the NLST and PLCO trials and incorporates birth-cohort-specific smoking trends and life expectancies. We estimated overdiagnosis using the cumulative excess-incidence approach, the annual excess-incidence approach, and the microsimulation approach. RESULTS Using the cumulative excess-incidence approach, 10.5 % of screen-detected cases were overdiagnosed in the 1950 birth-cohort compared to 5.9 % in the 1990 birth-cohort. Incidence peaks and drops due to screening were larger for older birth-cohorts than younger birth-cohorts. In the general US population, these differing incidence peaks and drops across birth-cohorts overlap. Therefore, annual excess-incidence would be absent between 2029-2040, suggesting no overdiagnosis occurs. Using the microsimulation approach, overdiagnosis among screen-detected cases increased from 7.1 % to 9.5 % between 2018-2040, while overdiagnosis among all lung cancer cases decreased from 3.7 % to 1.4 %. CONCLUSION Overdiagnosis studies should use appropriate methods to account for trends in background risk and screening eligibility in the general population. Estimates from randomized trials, based on the cumulative excess-incidence approach, are not generalizable to the general population. The annual excess-incidence approach does not account for trends in background risk and screening eligibility, and falsely suggests no overdiagnosis occurs in the general population. Using the microsimulation approach, overdiagnosis was limited but not nil. Overdiagnosis increased among screen-detected cases, while overdiagnosis among all cases decreased.

中文翻译：

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肺癌风险和筛查合格率的趋势会影响过度诊断的估计。

目的在美国普通人群中，由于肺癌筛查导致的过度诊断程度仍然未知。估计值可能会受到所用方法和吸烟趋势减少的影响，吸烟趋势会随着时间的流逝降低肺癌风险和筛查资格。因此，我们旨在使用三种不同的方法来评估美国普通人群中因肺癌筛查而引起的过度诊断程度。材料和方法假设完全遵守美国预防性工作队的建议，则使用MISCAN-Lung模型来预测2018-2040年美国普通人群的肺癌发生率和过度诊断。MISCAN-Lung已根据NLST和PLCO试验进行了校准，并纳入了特定于出生队列的吸烟趋势和预期寿命。我们使用累积的超额发生率方法估算了过度诊断的可能性，年度超额发生率方法和微观模拟方法。结果使用累积超量发生率方法，在1950年出生队列中筛查出的病例被过度诊断的比例为10.5％，而在1990年出生队列中则为5.9％。年龄较大的出生队列的筛查发病率高峰和下降幅度大于年龄较小的队列。在美国普通人群中，出生人群中这些不同的发病高峰和下降重叠。因此，在2029年至2040年之间将没有每年的过度发病率，这表明不会发生过度诊断。使用微模拟方法，在2018年至2040年之间，筛查病例的过度诊断率从7.1％增加到9.5％，而所有肺癌病例的过度诊断率从3.7％下降到1.4％。结论过度诊断研究应使用适当的方法来说明一般人群的背景风险趋势和筛查资格。基于累积超额发生率方法的随机试验得出的估计值不能推广到一般人群。年度超额发生率方法不能说明背景风险和筛查合格率的趋势，并且错误地表明一般人群中不会发生过度诊断。使用微观模拟方法，过度诊断是有限的，但不是零。在筛查到的病例中，过度诊断增加，而在所有病例中，过度诊断减少。年度超发病率方法不能说明背景风险和筛查合格率的趋势，并且错误地表明一般人群中不会发生过度诊断。使用微观模拟方法，过度诊断是有限的，但不是零。在筛查到的病例中，过度诊断增加，而在所有病例中，过度诊断减少。年度超额发生率方法不能说明背景风险和筛查合格率的趋势，并且错误地表明一般人群中不会发生过度诊断。使用微观模拟方法，过度诊断是有限的，但不是零。在筛查到的病例中，过度诊断增加，而在所有病例中，过度诊断减少。