Can screening decrease lung cancer mortality rates?
Lung cancer is a case in point. The disease kills more Europeans than any other cancer. More than 250,000 citizens of the EU-28 die annually.1 Lung cancer is often diagnosed late.2 The impact of the disease can be curbed by diagnosing cases as early as possible – maximising the opportunity for successful surgery or treatment.2
When diagnosed in the late stages of disease, the chances of being alive in five years’ time are not good: for those diagnosed with stage IV non-small cell lung cancer, the average five-year survival rates range from 2% to 13%.3 The outlook is considerably better when diagnosed at stage I. Globally, most patients (58-73%) whose lung cancer is picked up in the earliest stage live longer than five years.3
Reducing the burden
Low-dose computed tomography (LDCT) lung screening can identify early stage cancer. Clinical trials have shown that 10-year survival in computed tomography CT screen-detected cancer is 88%.3 That is even higher than the typical 5-year survival for early stage disease in clinical practice.4
So why is CT screening not widespread? One reason is that many of the small nodules picked up in screening are ‘false positives’. In the US National Lung Screening Trial (NLST), around 95% of abnormalities turned out to be false alarms.5 This led to undue worry for patients and costs to health systems. Selection of population and risk stratification are also essential to making screening cost-effective.6
Nonetheless, the NLST showed a reduction in lung cancer mortality of 20%.5 This is a phenomenal result: many people are alive today because they were included in this trial.
A brighter future
Other innovative technologies, such as Electromagnetic Navigation Bronchoscopy (ENB) – a minimally invasive approach to visualising and accessing difficult-to-reach areas of the lung – provide for further early diagnosis opportunities.7
New technologies will allow us to go every further by providing tools to triage patients prior to CT scanning. Molecular markers in the blood – or even in the breath – will help doctors to decide whether someone is a suitable candidate for low-dose CT screening.8 These ‘breathprint’ markers are hugely exciting and will transform cancer diagnostics in the decades to come. Artificial intelligence systems will also add new levels of sophistication to our triage systems. However, developing and validating such tools will take time.
Nonetheless, the European Respiratory Society and the European Society of Radiology, as well as a European Expert Group9, have called for lung cancer screening in Europe.10
An EU guideline on Lung Cancer Screening (LCS) could clarify how such screening should be designed to generate the best possible outcomes. This could be achieved by including early detection of lung cancer as a priority in the new Joint Action. To support the implementation of such screening programmes in Member States, EU Council Recommendations and the monitoring of their uptake are an effective tool.11
Based on this, we would argue that policymakers should act now to reduce the burden of lung cancer by implementing policies that enable screening. We have technologies that can save patients’ lives now. Let’s ensure patients have access to screening without further delay.
More than 250,000 citizens in the EU-28 die annually as a result of lung cancer according to Eurostat. The impact of the disease can be curbed by diagnosing cases as early as possible – maximizing the opportunity for successful surgery or treatment. In this video, Drs. Giulia Veronesi, Gaetano Rocco and Karl Klinger share with us some insightful views on the varying dimensions of this disease and what can be done in the future to tackle it.
1 Eurostat: Cancer Statistics – Specific Cancers http://ec.europa.eu/eurostat/statistics-explained/index.php/Cancer_statistics_-_specific_cancers#Lung_cancer (Accessed 6 February 2018)
2 European Respiratory Society: European Lung White Book https://www.erswhitebook.org/chapters/lung-cancer/ (Accessed 6 February 2018)
3 Sources: World Health Organisation, American Cancer Society, World Cancer Research Fund International, and Cancer Research UK
4 Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS: Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763–1771.
5 National Lung Screening Trial Research T, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395–409.
6 Yousaf-Khan U, van der Aalst C, de Jong PA, Heuvelmans M, Scholten E, Walter J, et al: Risk stratification based on screening history: the NELSON lung cancer screening study. Thorax DOI: 10.1136/thoraxjnl-2016-209892
7 Leong S, Ju H, Marshall H, et al. Electromagnetic navigation bronchoscopy: A descriptive analysis. Journal of Thoracic Disease. 2012;4(2):173-185. doi:10.3978/j.issn.2072-1439.2012.03.08.
8 Marc P. C. van der Schee, Jasper Boschmans, Rob Smith, Russell Parris, Billy Boyle, Duncan Apthorp, Simon Kitchen, Robert C Rintoul, The LuCID Consortium. Early detection of lung cancer through analysis of VOC biomarkers in exhaled breath: The LuCID study. European Respiratory Journal Sep 2017, 50 (suppl 61) OA1472; DOI: 10.1183/1393003.congress-2017.OA1472
9 Oudkerk, Matthijs et al. European position statement on lung cancer screening. The Lancet Oncology , Volume 18 , Issue 12 , e754 - e766
10 Kauczor HU1, Bonomo L, Gaga M, Nackaerts K, Peled N, Prokop M, Remy-Jardin M, von Stackelberg O, Sculier JP; European Society of Radiology (ESR); European Respiratory Society (ERS). ESR/ERS white paper on lung cancer screening. Eur Radiol. 2015 Sep;25(9):2519-31. doi: 10.1007/s00330-015-3697-0. Epub 2015 May 1.
11 As proven by the Council Recommendations of 2 December 2003 on screening for colorectal, cervical, and breast cancer (2003/878/EC) and the subsequent monitoring reports issued by the European Commission in 2008 & 2017