Screening Could Reduce Lung Cancer Deaths by One Quarter

Liam Davenport

July 14, 2021

Lung cancer remains the leading cause of cancer deaths worldwide, with nearly 2 million fatalities per year, but these deaths could be reduced by a quarter with more targeted lung screening, argues a new report.

Screening of high-risk individuals with low-dose computed tomography (LDCT) has been shown in clinical trials to shift the diagnosis of lung cancer to earlier stages.

This could "transform lung cancer from a fatal to a treatable condition, with considerable impact on quality of life" as well as a "considerable reduction in the number of deaths from lung cancer."

It also points out that fewer screens are required to prevent one lung cancer death than for other cancer types. The NELSON study found that one life could be saved for every 320 LDCT scans administered. This compares with one life saved for 864 tests for colorectal cancer and between 645 to 1724 scans for breast cancer.

However, screening for lung cancer is not as widely available as for breast and colorectal cancers.

The report argues it is time for national governments to consider large-scale implementation of targeted lung cancer screening.

The report, Lung cancer screening: the cost of inaction, was issued by the Lung Ambition Alliance on July 8 to mark its second anniversary.

This group describes itself as a "partnership of diverse organizations united in the quest to eliminate lung cancer as a cause of death." The founding partners were the International Association for the Study of Lung Cancer (IASLC), Guardant Health, the Global Lung Cancer Coalition, and AstraZeneca.

Shifting Diagnosis to Earlier Stages

"If you are able to make the diagnosis earlier you will get a higher proportion of patients in stage I or stage II that are potentially susceptible to radical resection," explained Giorgio Scagliotti, MD, PhD, from the University of Torino at San Luigi Gonzaga Hospital in Torino, Italy. He is also interim chief science officer of the IASLC and the group's past president.

"The bottom line" is that LDCT "is able to reduce significantly lung cancer mortality at 5 years", he told Medscape Medical News.

This is important, he added, because although targeted drugs and immunotherapies have improved survival in lung cancer, "it is not enough."

These drugs have resulted in a "clinically significant" survival benefit "but tumors are acquiring resistance" to the drugs, and "consequently patients will still die from the disease," he said.

The "vast majority of screen-detected tumors are diagnosed in stage I and stage II," where the 5-year survival is "much much higher," he said.

The report emphasizes that, currently, many lung cancer patients are diagnosed at an advanced stage, when treatment options are limited.

Only about 20% of patients are diagnosed at stage I, when the likelihood of survival at 5 years is between 68% and 92%, while over 40% are diagnosed when they are at stage IV, when the 5-year survival rate is less than 10%.

The report also notes that LDCT screening allows for early detection of other noncommunicable diseases (such as chronic obstructive pulmonary disease and cardiovascular disease), complements smoking cessation policies, and reduces overall healthcare costs.

Call for Increased Lung Screening

The report notes that not only is screening for lung cancer lagging behind that for other cancer types, policy change has been slow.

Only a few countries across the world have committed to introducing nationwide screening programs; they include the US, Japan, South Korea, Croatia, Poland, and Australia.

The report calls on governments to implement LDCT screening at scale in high-risk populations, and it provides implementation guidance based on decades of global research.

However, it adds that implementation requires high-quality multidisciplinary care, a reliable means of identifying people at highest risk, the inclusion of screening into overall prevention messages, and securing the attendance of vulnerable groups, among other factors.

There have already been some moves to increase LDCT screening, the report points out. 

It highlights the recent US Preventive Services Task Force Recommendation Statement, in which the definition of 'heavy smoker' was revised down from 30 pack-years to 20 pack-years to allow for inclusion of more women and non-Hispanic Black, Hispanic, and American Indian/Alaska Native individuals in lung cancer screening.

In addition, it highlights the Lung Health Check model adopted in England, which focuses on all respiratory diseases, rather than on cancer, to encourage uptake and overcome the stigma over smoking and the fear of lung cancer. Specifically, the invitation to have this 'lung check' does not mention smoking status or cessation nor lung cancer, and supportive interventions are offered as part of the wellness check.

No relevant financial relationships were reported. The report was developed for the Lung Ambition Alliance by The Health Policy Partnership and endorsed by the International Association for the Study of Lung Cancer. It was initiated and funded by AstraZeneca, a founding partner of the Lung Ambition Alliance.

Lung Ambition Alliance. "Lung cancer screening: the cost of inaction." Published online July 8, 2021. Full report

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