#lungcancer Europe awaits screening assessments for lung cancer

| January 13, 2016 | 0 Comments
cancercancerBy European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

In a Europe of 500 million people, all of us potential patients, it may come as a surprise that the biggest cancer killer of all does not have a solid set of screening guidelines across the EUs 28 member states.

Yes, the EU has its own study on the benefits of lung cancer screening because, as one would expect, it recognises that the societal impact of this disease is immense.

The US has, of late, had a 20% mortality reduction, shown in its National Lung Screening Trial (NLST) results.

Meanwhile, Europe awaits results from the Dutch-Belgian Nelson Trial, which may provide further evidence of a mortality reduction.

The wait may be up to four years, however, and that time lapse potentially represents a lot of unnecessary deaths.

As stated, lung cancer is the biggest global killer of all cancers. And fewer than half of newly diagnosed sufferers live beyond a year, with only around 16% surviving for five years.

It is such a huge killer partly because it is harder to detect in its early stages. By the time a person begins to notice symptoms, it has often spread to other parts of the body and is, therefore, difficult to treat.

The majority of lung cancers in both sexes are caused by smoking, but about 15% are not, and the majority of those non-smokers are women, mostly young women.

Treating patients has never been an easy task. In many cases truly difficult decisions need to be made. These decisions can often be made easier when clinical guidelines are in place.

These are made up of recommendations aimed at optimising patient care, and are based on existing evidence, systematically reviewed.

Clearly, prevention is better than cure and it is the case that, with lung cancer being so hard to detect, there are strong arguments for agreed recommendations on screening.

Doctors need to quickly identify high quality, trustworthy clinical practice guidelines, in order to improve decision making for the benefit of their patients.

In the US, the American Cancer Society stated that it had thoroughly reviewed the subject of lung cancer screening and issued guidelines that are aimed at doctors and other health care providers.

Some of these are obvious, given that we all know the risks that tobacco smoking poses. For example, the society says that patients should be asked about their smoking history. It adds that patients who meet all of the following criteria may be candidates for lung cancer screening.

Those criteria mentioned above are that the patient is between 55-74 years old, is in fairly good health, has at least a 30 pack-year smoking history and is either still smoking or has given up within the last 15 years.

Europe, among other things, is looking at risk prediction models to identify patients for screening, plus determination of how many annual screening rounds is enough.

Also, several uncertainties remain within the EU delaying the formulation of a universal policy for screening.

EU-based experts – John Field, from the University of Liverpool, Dr. Matthijs Oudkerk from the University of Groningen, as well as colleagues from London and Copenhagen – wrote in The Lancet that: Low-dose CT screening generates commercial interest, but clinical considerations are paramount. Several uncertainties remain within Europe to preclude formulation of a universal policy for screening.”

A total of eight European randomised trials have been set up to compare lung cancer CT screening with no screening at all, including trials in Italy, France, Denmark, Germany and the UK.

As mentioned above, the results of the Dutch-Belgian Nelson trial, the largest in Europe, are still pending, but will potentially strengthen the evidence and enable further questions about screening frequency and evaluation of abnormal screens to be addressed,” according to the expert team.

Meanwhile, the International Association for the Study of Lung Cancer (IASLC) has developed a consensus statement of issues needing more research. These include effective risk assessment, and integrating screening with anti-smoking information. Some experts have said that, while we wait, there is a good case for “immediate implementation of carefully designed and well targeted demonstration programmes.

Of course, cost-effectiveness questions arise whenever population-wide screening is considered, especially in relation to frequency and duration. Yet, the potential benefit of lowdose CT lung cancer screening would almost certainly see an improvement of the lung cancer mortality rate in Europe.

On the other hand, screening for lung cancer also has potential harms. These include radiation risks (increased risk of other cancers), identification of quite possibly benign nodules leading to more evaluation (perhaps biopsy or surgery), anxiety in the patient and his/her families, and over diagnosis/treatment of discovered cancers that would cause no ill effects during a patients lifetime.

So its a complicated issue. But the Brussels-based European Alliance for Personalised Medicine (EAPM) wants to see Europe place more focus on a guideline approach in this area.

It wants to see guidelines formulated through what it calls a SMART approach (Smaller Member states And Regions Together) drawn up at the national level and integrated into National Cancer Plans. This, it says, is preferable to a top-down legislative approach.

However, it does call on the EU to put guidelines in place that will allow Member States to set-up quality assured early detection programmes for lung cancer, adding that there is a need for increased public-private partnerships, such as IMI II.

Its recent White Paper on lung cancer also calls for increased collaboration between pharmaceutical researchers to find the best treatments for patients, which will reduce the cost burden for individual companies in developing treatment.

EAPM adds that all lung cancer patients urgently need action at the highest level, adding that improvements will depend primarily on greater collaboration between member states and across the healthcare sector. The collaboration should include patients, caregivers and patient organisations, who have an indispensable contribution to make.

And it makes clear that: More effort is needed in prevention. Public awareness of the disease and the risk factors should be developed, particularly among younger people, women and front-line healthcare professionals.

Among the White Paper’s ‘asks’ are the need for an acknowledgement that lung cancer is one of Europes biggest killers and that the European Union can play an important role in helping to tackle the disease.

It seems clear that a set of agreed guidelines will help front-line healthcare professionals assess whether screening a particular patient (based on various, properly evaluated circumstances) will reduce mortality rates in this killer disease.

Coupled with better information for patients, Europe could make significant inroads into tackling lung cancer.

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Category: A Frontpage, Cancer, EU, European Alliance for Personalised Medicine, Health, Personalised medicine

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