“Lung cancer kills more individuals each year than any other cancer because it is common and the majority of patients present with advanced stage disease. Despite this, there is no screening for lung cancer, in stark contrast to the established programmes for breast, cervical or colon cancer.
“Along with colleagues I wrote a recent review in Lancet Oncology to consider the prospects for the implementation of CT scanning for lung cancer in Europe within the next four years.
“A major development in lung cancer screening was announced in 2010, when a US trial demonstrated a 20% lung cancer mortality advantage (lives saved) in the CT scanned group of individuals, compared with those who had only a chest radiograph. This was followed up in 2013 by the US Preventive Services Task Force, which recommended implementation of lung cancer screening in North America.
“However, the insurance-based the US health care system differs significantly from that of the UK and the rest of Europe, with cost-effectiveness being a significant factor in any decision on this side of the Atlantic. To make this decision we need to await the outcome of the Dutch-Belgian lung cancer screening study (NELSON) and the pooling of the European trials in 2016, which will include data from the UK lung cancer screening trial (UKLS).
“The awaited outcome of these trials will potentially provide confirmation of a mortality advantage and cost-effectiveness for high risk individuals.
“In the interim, myself and the other authors of the Lancet Oncology review, ‘CT screening for lung cancer: countdown to implementation’, have identified the key issues which still need to be addressed.
“Of these, the most important are the interval between screening events, and issues relating to harms and benefits – including false-positive results. These questions could be answered with a demonstration project in the UK; this would need to incorporate effective smoking cessation education to increase cost-effectiveness.
“Even with the optimisation of low-dose CT screening – such as improved identification of high-risk individuals, imaging techniques, diagnosis of potentially cancerous nodules and better surgical approaches – some challenging decisions remain, given the present economic climate and the lack of funding for existing health care programmes.
“However, now we have this information at our disposal, I believe the time is right to increase public awareness of these issues with a national debate on the implementation of lung cancer screening – a measure that would save a significant number of lives.”
Registered users of the Lancet can read the full review here: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2813%2970293-6/abstract
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