#EAPM and #ERS event aims for ‘Big Screen’

| April 8, 2019
No, we’re not talking about the movies… But today, 8 April, will see the European Alliance for Personalised Medicine (EAPM) and the European Respiratory Society (ERS) hold a high-level event on lung-cancer screening at the University Foundation in Brussels, writes European Alliance for Personalised Medicine Executive Director Denis Horgan.

Entitled ‘Saving Lives, Cutting Costs’, the event will take place just ahead of the Alliance’s 7th annual presidency conference tomorrow (9 April), at the same venue, and this evening’s European Parliament dinner. Please see the Presidency Conference agenda

The dinner will feature speeches by MEPs and others focusing on innovation in health care and how policymakers can influence it.

The event also comes on the back of Sunday’s celebrations to mark the birthday of the World Health Organization. It was founded on 7 April, 1948.

On the same day, the ongoing discussions over plans for health technology assessment (HTA) are set to resume. This will be the sixth discussion on the Commission’s plans and will focus on funding, member state co-ordination and the IT platform.

The most contentious part of the talks could be the stakeholder network and who will be allowed to join it, concerns about conflict-of-interest and the need for transparency and accountability.

This makes a change from member states arguing about the mandatory aspects of the Commission’s plans, with Romania having chosen to put that issue aside during its presidency. Lucky old Finland, which is next up in the rotating role…

At the same time, EU health attachés will be given an update on implementing the blocs new medical device regulations, with the deadline for implementation 14 months away.

So far, BSI in the UK is the sole notified body approved to operate under the incoming rules, putting the Commission under pressure to show that the necessary work is being done and is about to bear fruit.

The need for screening

Back to the lung cancer event, and speaking ahead of today’s lung cancer forum  Bulgarian Alliance for Personalised and Precision Medicine (BAPPM) President Jasmina Koeva, who will give the opening address, said: “Screening is necessary and we need it now. It is at the very least surprising that the biggest cancer killer of all does not have a solid set of screening guidelines across Europe.”

Jørgen Vestbo, ERS Advocacy Council Chair, highlighted that, during screening, it a range of other heart and lung conditions can also be picked up.

EAPM’s Executive Director Denis Horgan said: “The Alliance has long had a focus on prevention, not least through screening programmes, and, during the course of several events on the topic since its formation, we and our stakeholders have looked at the right preventative measures to ensure reliable and sustainable health care for the long-term benefit of patients now and in the future.”

Both Horgan and Ms Koeva emphasized that lung cancer is one of the biggest killers on the planet. And while there is, of course, a well-documented direct connection between the disease and smoking, non-smokers also get lung cancer.

Horgan said: “We are all aware that by far the best way to reduce numbers of lung cancer patients is to persuade smokers to stop. But not all sufferers are, or have ever been, smokers.”

A deadly numbers game

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%).

Horgan said: “In its early stage, lung cancer has a very good prognosis over a five-year period. But this becomes much poorer in later stages, because treatment by then has little effect on preventing deaths.” 

It is now well recognized from multiple screening trials that if early stage lung cancers are identified and surgically resected, the patient has a very good five year survival rate.

Unfortunately, at this time, most patients are diagnosed at an advanced stage. Most experts believe that there is a strong case for lung cancer screening programmes across the EU’s member states to reduce the cases of advanced-stage lung cancer.

More guidelines required 

Against this background, EAPM, ERS and their broad stakeholder base has turned its attention to need for more guidelines across the arena of healthcare, especially in screening for lung cancer. There is a need for agreement and coordination across all of the European Union’s member states.

Ideally, guidelines could help to tether costs, by bringing in improvements to the efficiency of screening methodologies and, thus, programmes themselves.

Jan Van Meerbeeck, head of Thoracic Oncology Assembly at ERS, emphasised that the society is uniquely suited to implement lung -ancer screening in Europe, as its members are keen to collaborate with other scientific societies.

Key to such a situation would be making the best use of efficient risk-assessment methods, top-of-the-range imaging technology utilising volumetric protocols, and clinical work-up guidelines that encourage the minimization of invasive procedures and risk to the patient.

Many experts believe that 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.

Among recommendations currently being discussed in European forums are the setting of minimum requirements, which should include standardized CT screening radiological procedures for low-dose imaging, risk prediction criteria for inclusion – or exclusion – for screening, together with the integration of smoking cessation programmes.

Also important are improving the quality, outcome and cost-effectiveness of screening, reducing radiation risks, and thorough assessments of other risks, such as co-morbidities.

The European Respiratory Society 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”.

Cost versus benefit

Harry de Koning, Department of Public Health, Erasmus MC, Rotterdam, Netherlands said: “Of course, cost-effectiveness questions arise whenever population-wide screening is considered, especially in relation to frequency and duration. 

“But a UK lung cancer screening trial has demonstrated that screening is cost effective by NICE criteria, in the modelling of their pilot screening trial.” 

De Koning added: “The potential benefit of low-dose CT lung cancer screening would almost certainly see an improvement in the lung cancer mortality rate in Europe.”

EAPM and ERS believe that there is a need for the establishment of a central registry, including biobank and image bank, and preferably on a European level.

On top of this, 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.

“Now is the time to persuade policy-makers across the EU that this is an urgent societal need,” said Matthijs Oudkerk, Professor of Radiology, University of Groningen.

“And that means that it’s a political need.”

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