禁煙が肺がんのリスクを最も下げる

→5年間の禁煙で、肺がんのリスクを下げるエビデンスがある。細胞診検査や、胸部レントゲンでのフォローアップは死亡率の改善に寄与しない!

 

Smoking cessation is the best way to prevent deaths and complications from lung cancer and other diseases.
 
Smoking cessation is the best way to prevent deaths and complications from lung cancer and other diseases. There is evidence of risk reduction within 5 years of quitting smoking. In addition, case-control studies have demonstrated an 80% to 90% relative risk reduction for lung cancer in former smokers who have been abstinent for 15 years.
 
5年間の禁煙で、肺がんのリスク減少効果がある.
加えて、15年間の禁煙で、80-90%相対危険度の減少効果がある.
 
Chest radiograph and sputum cytology are not recommended as screening tools for lung cancer. Several large-scale controlled clinical trials have been performed and none of them demonstrated a mortality benefit for screening with cytology or chest radiography.
 
Recently the national lung screening trial demonstrated that screening with low-dose CT (LDCT) reduced mortality in a high-risk population (based on age and smoking history) compared with screening by radiograph (relative risk reduction of 20%). However, smoking cessation is still more likely to save a life than LDCT.
 
年齢や喫煙などで 肺がんのリスクが高い患者は、胸部レントゲンよりも、CTの方が、死亡率を減少させた。しかし、それでも禁煙の方が、生命を救う。
 
The U.S. Preventive Services Task Force does recommend annual screening for lung cancer with LDCT in adults age 55-80 years who have a 30-pack-year smoking history and currently smoke or have quit within the past 15 years. Candidates for screening should take part in shared decision making, which includes a discussion of benefits and risks. Ideally it should take place in the context of a multidisciplinary program to ensure that it is properly performed and downstream testing is managed appropriately.
 
Active smokers engaged in lung cancer screening should be counseled and assessed for smoking cessation at every opportunity.
 
上記のように考えられています。基本的には肺がんのリスク減少に関しては禁煙がベスト。そして、喫煙者で肺がんの心配をしている人に対しては、相談次第で胸部CTまで検討すると良いと思われます。
 
MKSAP18

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