#EAPM - Car trouble: Germany debates #DieselFumes ahead of #LungCancer summit

Following on from several conferences on the subject in recent years, the European Alliance for Personalised Medicine (EAPM) is organizing a round table on lung-cancer screening ahead of its 7th annual Presidency Conference in April, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan. 

The event will be held in association with the European Respiratory Society (ERS) on 8 April in Brussels. EAPM has been particularly active in the area of lung-cancer screening, and the timing of this latest event is in order to present a rationale and strategy, in light of the upcoming European Parliamentary elections in May, explaining why current and incoming MEPs should support an EU-wide programme.

A cornerstone of the strategy is to produce a coordinated plan on lung-cancer screening.  Putting the ‘die’ in diesel? The debate comes in the wake of Germany getting in a tizzy after claims by more than 100 of its lung doctors that fears about the effects on health of vehicle emissions are being exaggerated.

The experts questioned whether existing limits on pollutants from cars are justified and said current limits are mainly based on questionable epidemiological studies.

However, the claim has been disputed by the German Association of Pulmonologists, Sleep and Respiratory Doctors, which says the comments are "in clear contradiction” of long-standing views on the health impact of air pollution.

The German Society for Pneumology and Respiratory Medicine, meanwhile, has listed the effects of various pollutants on, among other things, the lungs, heart, organ system, brain and the health of unborn children. The society says that a "significant reduction in air pollution is required and a lowering of the legal limit values is necessary”.

But that hasn’t stopped the country’s transport minister, Andreas Scheuer, from writing  to European Commissioner for Transport Violeta Bulc, calling on the EU to review its legal pollution limits. Scheuer maintains that the 100+ doctors put “objectivity and facts into the diesel debate” saying he would lobby EU transport ministers on the issue in Council.

Germany’s environment minister, meanwhile, has rejected calls to stop roadside emissions tests that uncover excessive air pollution, and has some worried about a ban on diesel cars in cities. In the car-loving nation of Germany, this is where the debate all started. And it is far from being ‘exhausted’, with lobby groups beeping noisily and trying to jam on the brakes.

Varying viewpoints aside, scientifically it has been shown that citizens living in areas with high levels of particulate matter and nitrogen oxides on average die earlier than those living away from such pollution, but there is more than a little diesel-fuelled smog surrounding the issue. Other factors, including the usual unhealthy mix of smoking, alcohol consumption, lack of physical activity and so on are also thought to play their part in these early deaths.

And although the dental-chair nitrous oxide is found in diesel, it’s clearly no laughing matter. And so to screening…as the debate in Germany continues, the EAPM and ERS roundtable will focus mainly on this area. Comprehensive screening programmes have been in place for some time in respect of several other cancers, but not so lung cancer, the biggest killer of all, while guidelines and best practices shared across Member States are urgently required.

Since EU Health Ministers unanimously adopted a set of recommendations on cancer screening in December 2003, systematic population-based screening for breast, cervical and colorectal cancers, for which evidence-based, feasible and efficient screening strategies exist, has been shown to bring about cost-effective interventions.

Fifteen years ago the Council Recommendation detailed the fundamental principles of the best practices in cancer screening, and urged member states to take common actions to implement such programmes through a population-based approach with appropriate quality assurance at all levels.

A decade-and-half later, the majority of EU member states now have population-based breast cancer screening programmes, for instance.

Admirable NELSON

The long-awaited and recently published NELSON study into computed tomography (CT) screening of lung cancer has shown that such screening reduces deaths from the disease by 26% in high-risk asymptomatic men.

The findings also indicate that, with screening, the results could be even better in women.  NELSON rolled out across the Netherlands and Belgium 16 years ago 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.

Dr Harry De Koning, of Erasmus MC in The Netherlands, said when presenting the results: “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 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.

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.

EAPM Executive Director Denis Horgan said at the time of the NELSON results: “This certainly shows the benefits of lung-cancer screening, something we already knew. Now we will work even harder to persuade policymakers across the EU that this is an urgent societal need.” The upcoming round table will be a further example of these efforts.

Member states on board 

As an outcome of EAPM’s Congress in Milan at the end of last year, the planned forum in Brussels will involve experts from all across Europe and take into account various criteria developed by the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases.

The group was formed in July 2018, and could be tasked with asking the European Commission to become much more active in this area and present a Recommendation to the Council. Various member states have already shown a willingness to move forward in lung-cancer screening - particularly Poland, Denmark, Netherlands, and Croatia, which recently held the EU’s rotating presidency.

These member states, the Alliance and its stakeholders realize that, among other elements, what is required in Europe is: continuous screening monitoring, with regular reports; assured consistency and enhanced quality of commented data for the screening reports; reference standards for quality and process indicators should be developed and adopted, and; an update of the 2003 EU Council recommendations mentioned above should be on the table.

On top of this, the integration of primary and secondary preventive strategies through comprehensive approaches is required. All of the above will be discussed at the lung-cancer screening workshop, and it is envisaged that a coordinated plan will emerge, which will make its way to Commission policymakers and member state health system chiefs.  Meanwhile, in Germany, the doctors continue to fall out, but EAPM is hoping for consensus after its own important debate. Registration will open next week...

About EAPM

The European Alliance for Personalised Medicine brings together Europe's leading health-care experts and patient advocates to improve patient care by accelerating the development, delivery and uptake of personalised medicine and diagnostics. It is calling for the European Commission, the European Parliament and EU member states to help improve the regulatory environment so that patients can have early access to personalised medicine, and so that research is boosted.

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