EU

#EAPM - #NELSON trial reveals benefits of lung-cancer screening

Published

8 years ago

September 26, 2018

The long-awaited NELSON study into computed tomography (CT) screening of lung cancer has shown that such screening reduces lung cancer deaths by 26% in high-risk asymptomatic men. Unveiled in Toronto this week, the findings also indicate that with screening the results could be even better in women, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

NELSON rolled out across the Netherlands and Belgium in 2003 and was eventually made up of 15,792 individuals in controlled trials, with a follow-up period of no less than ten years for survivors.

Speaking in Toronto to launch the results, Dr Harry De Koning, of Erasmus MC in the Netherlands, said: “These findings show that CT screenings are an effective way to assess lung nodules in people at high risk for lung cancer, often leading to detection of suspicious nodules and subsequent surgical intervention at relatively low rates and with few false positives, and can positively increase the chances of cure in this devastating disease.”

Explaining that NELSON was the second-largest such trial ever conducted, he added: “These results should be used to inform and direct future CT screening in the world.”

To put lung-cancer screening in perspective, the disease kills more Europeans than any other cancer. In 2013, 269,000 citizens of the EU-28 died as a result and ‘crude’ lung cancer incidence is on the rise, largely due to the ageing population.

Yet, in its early stage, lung cancer has a very good prognosis over a five-year period which becomes a great deal poorer in later stages, as treatment by then has little effect on preventing deaths.

NELSON has demonstrated this and shown unequivocally that screening has the potential to detect lung cancer at an early stage.

What the stakeholders say

Denis Horgan greeted the news by saying: “These results back up EAPM’s work in conjunction with key medical societies in the arena in putting the case for lung-cancer screening on the political agenda. This has been done not least through two conferences under the rotating EU Presidencies of Bulgaria in 2017 and Malta in April this year.”

“There is clearly a case for such screening and the results from NELSON cannot be ignored.”

Horgan pointed out that EAPM was an early adopter of the case to support lung-cancer screening in the European Union, not least due to the benefits that early diagnosis would bring to the patient.

He added: “This has been a key focus of our work which highlights the multi-stakeholder efforts of EAPM as we act as a platform allowing scientists, researchers and patients, for example, to meet and communicate with policymakers.”

This is reflected by the fact that key researchers behind the NELSON study worked with EAPM in order to develop a feasible policy landscape.

Former European health commissioner David Byrne, who successfully pushed for smoke-free pubs and restaurants across the EU while in Brussels, had put prevention as a key pillar of his chairmanship of the board of EAPM.

Since then, the Alliance has had numerous engagements at European Parliament, Commission and national level to put the case for lung-cancer screening firmly on the table. From this, EAPM has published a paper in The Lancet alongside an EU policy document.

The Alliance will now move further to seek to establish agreed guidelines during its upcoming Congress in Milan (26-28 November), with a joint meeting of EAPM, INAIL, IASLC and Humanitas.

Milan-based Giulia Veronesi, of the Italian city’s Humanitas Research Hospital, pointed out that lung cancer is the biggest killer of all cancers, responsible for almost 270,000 annual deaths in Europe.

She said: “Most experts in the field have agreed that Europe’s health systems need to adapt quickly to allow patients and citizens to benefit from early diagnosis of lung cancer and reduce mortality for this lethal disease.

“NELSON certainly shows the benefits of lung-cancer screening, something we already knew. Now we will work even harder to persuade policy-makers across the EU that this is an urgent societal need.”

Fellow cancer expert John Field, of the University of Liverpool, said that “besides the assessment of potential economic impact to start implementation, we absolutely need to establish guidelines to ensure effective and safe implementation of lung-cancer screening in Europe”.

“Europe should certainly focus,” Field added, “on screening individuals known to have a high risk of developing lung cancer.”

Future policy on lung-cancer screening

EAPM and its stakeholders have previously put forward the opinion that, for screening to be cost effective, it has to be applied to the population at risk. For lung cancer, this is not simply based on age and sex, as in the majority of breast or colon cancer screening, the Alliance says.

We still have many questions to answer regarding methodology and guidelines for standardization of the screening process, such as how often do we screen individuals, and how to include smoking cessation activity and education on healthy lifestyle within the screening. There are also economic questions to be answered regarding screening and those educational programmes.

It has also pointed out that reducing ‘false positive’ cases is a key element in lowering the economic and human costs of a large-scale lung cancer screening, and suggested that Europe should set up a central registry for CT-screened individuals while involving all key groups in the EU in developing recommendations for implementation, adapted according to the health-care landscape of individual nations.

Jasmina Koeva from the Bulgarian affiliate of EAPM said: “Detection of early stage lung cancer with successful surgical intervention, improves the quality of life for affected patients.

“A stage shift related to screening will allow EU countries to reduce the cost of treatment given that treating early-stage lung cancer has half the cost of treatment at an already advanced stage.”

The Alliance says that each country in Europe would consider the decision to implement lung-cancer screening within their own health service mechanisms and procedures, while also basing this on the implementation of current screening programmes for other cancers.

EAPM has also called for an EU Council recommendation to initiate work on a EU Expert Group ”that reflects the experience with the existing recommendations and guidelines for other cancers”.

This, the Alliance says, should leverage the experience made aimed at harmonizing access for patients to such early detection programmes across the member states.

The bottom-line is that the NELSON study is now out there for all to see and has gone a long way towards settling the argument about the effectiveness of lung-cancer screening.

Now is the time to act and, by doing so, save lives.

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