Lung cancer

Lung cancer screening evidence contested at ERS 2020

There is now “more than enough” evidence to implement screening programs for lung cancer, the lead author of a European Respiratory Society review paper on the topic told delegates at the society’s virtual annual conference.

In a debate session during ERS2020, Professor Hans-Ulrich Kauczor from the University of Heidelberg said there were 400,000 deaths a year in Europe from lung cancer.

“We should do something and we can do something about it because we now have more than enough evidence to get something started,” he told the conference.

Professor Kauczor, co-authored an updated statement from the ERS and European Society Radiology this year which concluded “now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry”.

He pointed to evidence from the US National Lung Cancer Screening Trial and European Nelson study showing significant reductions in lung cancer mortality which was also confirmed by the German Lung Cancer Screening Intervention study

“There is evidence out there which led ESR/ERS joint statement in 2020,” he said.

“It does not provide recommendations but it’s a statement on the pivotal points to consider in lung cancer screening and how to introduce without harms.”

He added that some issues, including overdiagnosis, still needed addressing but that lung cancer screening should be set up and developed into general prevention programs for high-risk patients.

“There is an unmet need which is longer survival in lung cancer we need more political awareness and priorities on such programs.”

Programs which had been put in place to date in Croatia and pilot schemes in the UK have been interrupted due to COVID-19, delegates heard.

But in a counter view in the debate-style session, Professor Joachim Ficker from the University of Nuremberg said while the data on screening was promising, the fact that no changes had been shown in all-cause mortality was a problem.

“There is at best a very small effect on all-cause mortality if at all,” he said saying that studies had provided evidence of clear overdiagnosis.

“Overdiagnosis leads to unnecessary diagnostic procedures, unnecessary operations and unnecessary costs,” he said.

“Indeterminate results leads to further CT scans. This is not a rare event. For every lung cancer detected 10 patients have had extra scans.”

He added that high rates of false positives was a substantial problem and that there was “great uncertainty” about the gender difference between the impact of screening in men and women. An issue not helped by the fact that only 16.4% of those in the NELSON trial were female.

“The art of lung cancer screening is about finding a balance between benefit and harm,” he added.

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