Screening for Bronchiogenic Carcinoma – Yes or No?

Kurzfassung:

Lung cancer is among the most frequent cancers worldwide with a mean 5-year survival clearly below 20% and smoking being the leading risk factor. In the past, chest radiography and sputum have been investigated as screening tools, but negative results were obtained from randomized trials. In the following, randomized controlled trials were initiated with the „National Lung Screening Trial“ in the U.S. being the first to prove that CT screening is capable to reduce lung cancer mortality in heavy smokers by 20%. Since then, different medical societies in the US recommend annual CT screens for high risk individuals, and in 2015 the US officially introduced a lung cancer screening program with the costs covered. At the same time the discussion in Europe is highly controversial. It is obvious, that lung cancer screening can only be successful if experts from different disciplines collaborate in a comprehensive program with smoking cessation counselling and the complex processes clearly defined, certified and quality assured. This will be key to reduce false positive screen results, complications during further diagnostic work-up and radiation exposure. Also measures to increase pretest probability, e.g. by considering additional risk factors, have to be implemented in risk models in order determine the adequate intervals of CT screening as well as the relevance of the overdiagnosis bias. On top of this the scope of screening should be extended beyond the detection of nodules to a comprehensive risk assessment of smokers, including among others emphysema, airway disease, vascular disease. Cost-effectiveness has to be considered on a national level. Independent, central registration of screening data including image database and biobank, should help to assess and confirm the quality and positive effects of lung cancer screening.

Lernziele:

To appreciate the evidence in lung cancer screening To learn about the recommendations for setting-up a high quality lung cancer screening program