{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T08:58:12Z","timestamp":1791449892911,"version":"4.3.3"},"reference-count":35,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Oncol"],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended.<\/jats:p><\/jats:sec>Design, Settings, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Current and prior tobacco use.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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.<\/jats:p><\/jats:sec>Results<\/jats:title>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 (&amp;lt;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\u2013adjusted 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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoncol.2022.2952","type":"journal-article","created":{"date-parts":[[2022,7,28]],"date-time":"2022-07-28T16:00:51Z","timestamp":1659024051000},"page":"1428","source":"Crossref","is-referenced-by-count":31,"title":["Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended"],"prefix":"10.1001","volume":"8","author":[{"given":"Charles","family":"Faselis","sequence":"first","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, George Washington University, Washington, DC"},{"name":"Department of Medicine, School of Medicine, Uniformed Services University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel A.","family":"Nations","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, Uniformed Services University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charity J.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jared","family":"Antevil","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, Uniformed Services University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey M.","family":"Roseman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, University of California, Los Angeles, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen M.","family":"Sheriff","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Trachiotis","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Surgery, School of Medicine, George Washington University, Washington, DC"},{"name":"Department of Biomedical Engineering, School of Engineering and Applied Science, George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Allman","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, George Washington University, Washington, DC"},{"name":"Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Deedwania","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Zeng-Trietler","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, George Washington University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel D.","family":"Taub","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiya A.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Veterans Affairs Medical Center, Washington, DC"},{"name":"Department of Medicine, School of Medicine, George Washington University, Washington, DC"},{"name":"Department of Medicine, School of Medicine, Georgetown University, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"coi220036r1","first-page":"1","article-title":"Lung cancer incidence trends among men and women\u2013United States, 2005-2009.","volume":"63","author":"Henley","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"5","key":"coi220036r4","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1056\/NEJMoa1102873","article-title":"Reduced lung-cancer mortality with low-dose computed tomographic screening.","volume":"365","author":"Aberle","year":"2011","journal-title":"N Engl J Med"},{"issue":"6","key":"coi220036r5","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1056\/NEJMoa1911793","article-title":"Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial.","volume":"382","author":"de Koning","year":"2020","journal-title":"N Engl J Med"},{"issue":"10","key":"coi220036r7","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1001\/jama.2021.1117","article-title":"Screening for lung cancer: US Preventive Services Task Force recommendation statement.","volume":"325","author":"Krist","year":"2021","journal-title":"JAMA"},{"key":"coi220036r8","doi-asserted-by":"publisher","DOI":"10.1016\/1047-2797(91)90005-W"},{"key":"coi220036r9","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12874-015-0004-3","article-title":"Comparison of risks of cardiovascular events in the elderly using standard survival analysis and multiple-events and recurrent-events methods.","volume":"15","author":"Ip","year":"2015","journal-title":"BMC Med Res Methodol"},{"issue":"5","key":"coi220036r10","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1161\/CIRCULATIONAHA.106.628347","article-title":"Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial.","volume":"114","author":"Ahmed","year":"2006","journal-title":"Circulation"},{"issue":"2","key":"coi220036r11","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1161\/CIRCULATIONAHA.109.887570","article-title":"Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure.","volume":"121","author":"Meyer","year":"2010","journal-title":"Circulation"},{"issue":"5","key":"coi220036r12","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1161\/HYPERTENSIONAHA.111.178178","article-title":"Isolated diastolic hypotension and incident heart failure in older adults.","volume":"58","author":"Guichard","year":"2011","journal-title":"Hypertension"},{"issue":"4","key":"coi220036r13","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1161\/CIRCHEARTFAILURE.114.001885","article-title":"Risk of heart failure and death after prolonged smoking cessation: role of amount and duration of prior smoking.","volume":"8","author":"Ahmed","year":"2015","journal-title":"Circ Heart Fail"},{"key":"coi220036r16","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2021.12.021"},{"issue":"4","key":"coi220036r17","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/1047-2797(94)00092-8","article-title":"Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study.","volume":"5","author":"Psaty","year":"1995","journal-title":"Ann Epidemiol"},{"key":"coi220036r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2021.07.010","article-title":"Income disparity and incident cardiovascular disease in older Americans.","author":"Faselis","year":"2022","journal-title":"Prog Cardiovasc Dis"},{"issue":"11","key":"coi220036r19","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1093\/oxfordjournals.aje.a009066","article-title":"Exercise intensity and subclinical cardiovascular disease in the elderly: the Cardiovascular Health Study.","volume":"145","author":"Siscovick","year":"1997","journal-title":"Am J Epidemiol"},{"issue":"3","key":"coi220036r20","doi-asserted-by":"publisher","first-page":"1905","DOI":"10.1016\/j.ijcard.2012.12.053","article-title":"Prevention of heart failure in older adults may require higher levels of physical activity than needed for other cardiovascular events.","volume":"168","author":"Patel","year":"2013","journal-title":"Int J Cardiol"},{"issue":"4","key":"coi220036r21","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1111\/j.1532-5415.2010.02770.x","article-title":"Long-term retention of older adults in the Cardiovascular Health Study: implications for studies of the oldest old.","volume":"58","author":"Strotmeyer","year":"2010","journal-title":"J Am Geriatr Soc"},{"issue":"2","key":"coi220036r22","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1161\/CIRCULATIONAHA.115.018610","article-title":"Study of cardiovascular health outcomes in the era of claims data: the Cardiovascular Health Study.","volume":"133","author":"Psaty","year":"2016","journal-title":"Circulation"},{"issue":"6","key":"coi220036r23","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1161\/CIRCULATIONAHA.115.017719","article-title":"Introduction to the analysis of survival data in the presence of competing risks.","volume":"133","author":"Austin","year":"2016","journal-title":"Circulation"},{"issue":"8","key":"coi220036r24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255313","article-title":"Competing risk of mortality in association studies of non-fatal events.","volume":"16","author":"Buzkova","year":"2021","journal-title":"PLoS One"},{"issue":"10","key":"coi220036r25","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1007\/s00198-019-05048-w","article-title":"Assessing risk factors of non-fatal outcomes amid a competing risk of mortality: the example of hip fracture.","volume":"30","author":"Buzkova","year":"2019","journal-title":"Osteoporos Int"},{"issue":"2","key":"coi220036r26","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1093\/aje\/kwp107","article-title":"Competing risk regression models for epidemiologic data.","volume":"170","author":"Lau","year":"2009","journal-title":"Am J Epidemiol"},{"issue":"14","key":"coi220036r27","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1001\/jama.2020.1267","article-title":"Why test for proportional hazards?","volume":"323","author":"Stensrud","year":"2020","journal-title":"JAMA"},{"issue":"6","key":"coi220036r28","doi-asserted-by":"publisher","first-page":"e643","DOI":"10.1200\/JOP.2015.009605","article-title":"Typical time to treatment of patients with lung cancer in a multisite, US-based study.","volume":"12","author":"Vidaver","year":"2016","journal-title":"J Oncol Pract"},{"issue":"29","key":"coi220036r29","first-page":"501","article-title":"Chronic disease reports: deaths from lung cancer\u2014United States, 1986.","volume":"38","author":"Centers for Disease Control (CDC)","year":"1989","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"coi220036r30","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1136\/tobaccocontrol-2018-054593","article-title":"Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014-2016.","volume":"29","author":"Sharapova","year":"2020","journal-title":"Tob Control"},{"issue":"10","key":"coi220036r31","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1001\/jama.2021.1077","article-title":"Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force.","volume":"325","author":"Meza","year":"2021","journal-title":"JAMA"},{"issue":"5","key":"coi220036r32","doi-asserted-by":"publisher","first-page":"311","DOI":"10.7326\/M13-2316","article-title":"Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force.","volume":"160","author":"de Koning","year":"2014","journal-title":"Ann Intern Med"},{"issue":"11","key":"coi220036r33","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1001\/jamaoncol.2020.4331","article-title":"Validation of a machine learning algorithm to predict 180-day mortality for outpatients with cancer.","volume":"6","author":"Manz","year":"2020","journal-title":"JAMA Oncol"},{"issue":"11","key":"coi220036r34","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1001\/jama.2020.0592","article-title":"Effect of a machine learning-derived early warning system for intraoperative hypotension vs standard care on depth and duration of intraoperative hypotension during elective noncardiac surgery: The HYPE Randomized Clinical Trial.","volume":"323","author":"Wijnberge","year":"2020","journal-title":"JAMA"},{"key":"coi220036r2"},{"key":"coi220036r6"},{"key":"coi220036r3","unstructured":"Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Smoking cessation: a report of the surgeon general. US Department of Health and Human Services; 2020. https:\/\/www.cdc.gov\/tobacco\/sgr\/2020-smoking-cessation\/index.html#full-report2020"},{"key":"coi220036r14","unstructured":"CHS Investigators. The Cardiovascular Health Study: record 8, baseline personal history. Accessed June 22, 2022. https:\/\/biolincc.nhlbi.nih.gov\/media\/studies\/chs\/rec08.pdf"},{"key":"coi220036r15","unstructured":"CHS Investigators. The Cardiovascular Health Study: record 8, CHS data collection forms. Accessed June 22, 2022. https:\/\/chs-nhlbi.org\/forms\/r8p2"},{"key":"coi220036r35","unstructured":"U.S. Cancer Statistics Working Group. US cancer statistics data visualizations tool, based on 2020 submission data (1999-2018): US Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute. Updated 2022. Accessed June 22, 2022. https:\/\/www.cdc.gov\/cancer\/dataviz."}],"container-title":["JAMA Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/articlepdf\/2794805\/jamaoncology_faselis_2022_oi_220036_1666196325.76956.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,20]],"date-time":"2022-10-20T15:07:40Z","timestamp":1666278460000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaoncology\/fullarticle\/2794805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,1]]},"references-count":35,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoncol.2022.2952","relation":{},"ISSN":["2374-2437"],"issn-type":[{"value":"2374-2437","type":"print"}],"subject":[],"published":{"date-parts":[[2022,10,1]]}}}