#EAPM - How April could be the end of May… (and the case for lung-cancer screening)

The UK premier was bunkered at her official country residence, Chequers, on Sunday (24 March) trying to save her political career, according to several reports.

No such troubles across The Pond for ‘the Donald’, though, where the US president must be feeling pretty pleased that he’s seemingly off the hook (if he was ever actually on it) about pre-election collusion with Russia and obstruction of justice.

President Trump was, of course, in celebratory mood on Twitter while, in contrast, 10 Downing Street is staying schtum about Mrs May’s intentions as a series of votes - some even possibly ‘meaningful’ - are set to swamp parliamentary business in the coming days.

Also, at the weekend, a huge march of ‘Remainers’ calling for a second ‘people’s vote’ on Brexit hit the headlines, alongside an online petition garnering millions of supporters also making waves and calling for Article 50 to be revoked.

Meanwhile, the EU for its part is totally aware that, however uncertain (read ‘bad’) things already are in respect of Brexit, there’s a chance they could get a lot worse. As ever, we wait…

Hopefully, by the time of EAPM’s 7thannual presidency conference) on 8-9 April things will be at least a little clearer, but nobody’s placing any bets. Register here.

Regardless, it’s business as usual for the Alliance as, in partnership with the European Respiratory Society (ERS), it hosts an event on lung-cancer screening, entitled ‘The case for lung cancer screening: Saving Lives, Cutting Costs’.

(This also coincides with colorectal cancer month. Colorectal cancer is the third most commonly diagnosed cancer, and the fourth leading cause of cancer-related death.)

Numbers game

We are all aware that by far the best way to reduce numbers of lung cancer patients is to persuade smokers to stop. Although not all sufferers are, of have ever been, smokers.

High-risk groups exist, of course, and early diagnosis is vital. Currently, five-year survival rates stand at a mere 13% in Europe and 16% over in America.

It is the most commonly found cancer in men and lung cancer in women is being represented by a “worrying rise” according to the World Health Organization.

Some one billion people on the planet are regular smokers. And figures show that lung cancer causes almost 1.6 million deaths each year worldwide, representing almost one-fifth of all cancer deaths.

Within the EU, meanwhile, lung cancer is also the biggest killer of all cancers, responsible for almost 270,000 annual deaths (some 21%).

The ERS and the European Society of Radiology, have recommended screening for lung cancer under the following circumstances: “In comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres.”

Meanwhile, the International Association for the Study of Lung Cancer (IASLC) Strategic Screening Advisory committee (SSAC) developed a consensus statement after the publication of the NLST trial identifying issues which required further research. These include effective risk assessment, and integrating screening with anti-smoking information.

The SSAC experts indicated 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.

The UK lung cancer screening trial (UKLS) has demonstrated that screening is cost effective by NICE criteria, in the modelling of their pilot screening trial.

The potential benefit of low-dose CT lung cancer screening would almost certainly see an improvement in the lung cancer mortality rate in Europe.

NELSON and victory?

The NELSON study into computed tomography (CT) screening of lung cancer showed that such screening reduces lung cancer deaths by 26% in high-risk asymptomatic men.

The findings also indicated that, with screening, the results could be even better in women.

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.

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.”

De Koning will deliver a keynote address at the EAPM/ERS event.

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

EAPM executive director Denis Horgan said of the results: “NELSON certainly shows the benefits of lung-cancer screening, something we already knew. Now we will work even harder with our partners such the ERS, ESR and ECCO, to persuade policymakers across the EU that this is an urgent societal need.”

What next?

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 it is in the majority of breast or colon cancer screening.

Europe needs to involve all key groups in developing recommendations and guidelines for implementation, adapted according to the health-care landscape of individual countries.

Various member states have already shown a willingness to move forward in lung-cancer screening, and several countries’ health attachés will take part in the event.

The Alliance and its stakeholders realise 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.

The EU should put guidelines in place that will allow member states to set-up quality assured early detection programmes for lung cancer, and that there is a need for increased public-private partnerships, such as IMI II.

All of the above will be discussed at the lung-cancer screening event, and it is envisaged that a co-ordinated plan will emerge, which will make its way to Commission and Parliament policymakers and Member State health system chiefs.

It is clear than any further delay to the implementation of the best form of lung-cancer screening will mean many more unnecessary lives lost.

Brexit may still be uncertain. The value of lung-cancer screening, however, is not.

To register for the EAPM’s 7th annual presidency conference on 8-9 April, please click here.