Lung CancerLung cancer takes many lives. We can do more to prevent and detect the disease at a early stage. Explore how a lung cancer screening program can reduce mortality.

Lung cancer is often diagnosed at a late stage when the cancer is already advanced. The earlier the condition is diagnosed, the more likely a successful outcome. Studies show that lung cancer screening programs for those at high risk can save lives. Why not start now?

A person’s risk of developing lung cancer depends on many factors, including age, genetics, lifestyle and exposure to risk factors. Since this form of cancer is so dangerous with a high level of mortality, lung cancer specialists in many countries are now calling for national lung screening programs for high-risk individuals.

Benefits from CT screening

The National Lung Screening Trial (NLST) from the US and the NELSON study from Belgium and the Netherlands are the largest studies conducted on the benefits of low dose CT in lung screening. Over 50,000 people participated in the NLST from the United States, and they were smokers who had smoked 20 cigarettes daily and more for thirty years. The study showed an improvement in survival for the group receiving low-dose CT screening, compared with the control group receiving x-rays.

The NELSON study has followed over 15,000 participants for ten years and shows good effect of lung screening. Low-dose CT examinations of smokers in the high-risk age group was also the chosen screening method in the NELSON study. The final conclusions from the study that now have been published, documents that mortality was reduced by 24 per cent in men and 33 per cent in women, compared to patients who did not undergo screening.

Lung cancer takes most lives

In the Nordic countries many clinical specialists and scientists have commented in the media about lung screening programs. Radiologist Haseem Ashraf holds a doctorate in lung cancer screening and is a member of the Screening Committee for the Norwegian and Danish Lung Cancer Groups. He believes that the findings from the studies indicate that lung screening of heavy smokers in Norway should be put in place.

”Lung cancer is the cancer disease that takes the most lives both in Norway and internationally. When we have a method of significantly reducing mortality, why not use it? Now we have two large studies from the last ten years that show that we can save lives by introducing a screening program. Because one can detect the cancer before it spreads, it is possible to offer curative treatment,” says thoracic radiologist and associate professor Haseem Ashraf at the University of Oslo.

Early detection is crucial

The screening committee in the Norwegian lung cancer group has estimated that seven to eight percent of the Norwegian population in the age group between 55-75 years will meet the criteria for lung screening. Since not everyone will accept, they believe about 50,000 may be relevant estimate for screening annually.

”A lung cancer screening program should be as self-evident as other screening, if it is well established in scientific studies. When two large studies have shown positive results on CT low-dose screening, there is every reason to consider whether Norway should initiate targeted screening for this disease,” says the Head of the Norwegian Radiographer Federation, Bent Ronny Mikalsen to Hold Pusten Magazine.

He believes that available imaging and pathology capacity will be a key issue when the authorities make the decision regarding the introduction of a screening program for lung cancer.

Right selection

Ph.D. Zaaigham Saghir is a Clinical Associate Professor and specialist in lung medicine at Herlev and Gentofte Hospital and the University of Copenhagen in Denmark. He has the following comment on lung screening to the Danish Diagnostic Journal:

”There is no doubt that screening works, but we may be better at selecting those to be screened. We should find those at the highest risk and avoid overdiagnosis. We are already seeing good results, so it is just to get started with the high-risk patients and be better at differentiating them all the time,” says Zaigham Saghir.

He also comments on studies conducted in Denmark that show the same results as NELSON and NLST.

”We saw that screening during a five-year period did not produce significant results. But when we followed up with five more years, we could see effects with the highest risk patients. It will be exciting to analyse the results when we also follow-up beyond a 10-year period, says Saghir.

The Danish Lung Cancer Group (DLCG) believes that lung screening should be carefully organized to produce results.

”Screening, which is not systematized and organized, has a high risk of ending up in waste of resources. DLCG is therefore working to define how screening for lung cancer with low-dose CT can best be implemented in Denmark,” DLCG writes in a recent article in the Danish Journal of Medicine.

Commitment in Sweden

In Sweden the scientific lung cancer community have committed to accelerate a national lung screening program for high-risk patients. Every day 10 people die of lung cancer in Sweden.

In a chronicle in the Swedish Dagens Medicin Magazine, Roger Henriksson, Hirsh Koyi, Eva Brandén and Tommy Björk write:

“We propose that the National Board of Health, based on the new findings and the new technology that is available, can prepare the conditions for introducing organized lung cancer screening throughout Sweden, combined with effective preventive measures to achieve the goal of total smoking cessation. The cost of conducting screening and subsequent necessary treatment is lower than the cost of treating a patient who is affected by advanced, severe lung cancer, which is very rarely treatable. Especially when the screening is combined with smoking cessation, the health-economic benefit for society is big.”

With the CT platform SOMATOM go. Siemens Healthineers has the technology to contribute to make lung cancer screening with low-dose CT efficient and comfortable.

“Our new CT platform is an innovative and easy way to use a CT. The examination is done in a few seconds, and the radiation doses are down against the radiation doses known from ordinary x-ray. With the CT examination you get three-dimensional images and thus a far better overview than with ordinary X-ray. Suspected pathological changes can be detected very early,” says product specialist for CT Kjell Fladstad in Siemens Healthineers Norway.

Mobile CT scanning in UK

Siemens Healthineers in the UK has completed a lung screening project for high-risk patients with a mobile CT scanner in Manchester, and it may be possible to use this model in the Nordic countries. The model has been made possible through collaboration with several organizations.

“With the right partners and funding in place, our goal is to contribute to the implementation of lung screening programs in the Nordic countries. Based on recent research and the feedback from the scientific and clinical communities in our countries, I believe it is high time to introduce lung cancer screening of high-risk groups,” says Lars Karlsson, Head of Diagnostic Imaging in the Nordic and Baltic countries in Siemens Healthineers.
 

Treating late-stage lung cancer is extremely challenging. However, lung cancer treatment can be significantly more effective if the disease is detected earlier in stage I or II, before the onset of symptoms when the disease is still localized. This emphasizes the benefit to establish screening programs for earlier detection. Precise lung cancer staging of lymph node involvement and distant metastases determines the prognosis and is the foundation of adequate therapy selection.

Today, the majority of lung cancer cases is detected when the disease is already in an advanced stage – and so treatment of lung cancer primarily consists of either radio(chemo)therapy potentially followed by surgery or systemic chemotherapy.
But therapy planning for lung cancer patients and the appropriate therapy selection also depends on the patient’s condition, histological and molecular characteristics of the tumor, and staging information.

The success of therapeutic approaches is based on meaningful image information that helps to guide targeted therapy. For most tumors that are detected early and are still localized, the treatment of choice in lung cancer is primary surgery.

Therapy monitoring and follow-up of lung cancer are key to individualized patient treatment. Monitoring the tumor’s response allows a timely adaptation to the selected therapy. This is important when several therapeutic options are available, as is the case with lung cancer.

After completion of the therapy, a systematic follow-up for the early detection of lung cancer relapse should always be part of the patient’s workup and is described in the corresponding guidelines.

• comprehensive menu of oncology tests, e.g. general and specific tests to assess side-effects in the patient or tumor markers such as carcinoembryonic antigen (CEA)