#EAPM: Beating lung cancer against the odds - Changing Goal Posts

Many of the ideas behind lung-cancer screening are good ones,. After all, this is the biggest cancer killer of all we’re talking about. But the odds against its effective implementation across member states any time soon are high, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.

Maybe not quite so high as Barcelona’s incredible comeback after being four-nil down against PSG this week but still high enough. (The Catalans won the second-leg 6-1 to go through 6-5 on aggregate, with two minutes of normal time remaining they still needed three goals, but got them. How about €10 on THAT result?)

Apart from the arguments against possible over-treatment (which come with the territory in screening programmes - breast and prostate, for example), That discussion has taken place for some time on both sides of the Atlantic and shows no sign of abating any time soon, with many arguing, for example, that over-testing can very easily lead to this over-treatment, in-cluding unnecessary invasive surge.

Also, there’s the simple issue of whether enough suitable scanners are available (not just for the initial screening but for regular follow-up checks), waiting lists and, in some cases, the availability of enough trained staff. It’s all about resources, or lack thereof, as usual.

Cash is the usual political football, of course.

Obtaining the necessary risk data is another challenge as is public participation. You can’t force someone to go for screening so persuading them is vital if lives are to be saved. To do this, the potential patient needs to know that he or she doesn’t have to wait six months for something that may well be merely precautionary.

Should there be a propensity towards lung cancer in the family, in the subjects socioeconomic group, or the subject has stacked up plenty of smoking years, it may be easier. But, as men-tioned, where’s that in-advance accurate risk data?

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Basically, we need to find better ways of persuading the at-risk masses to put themselves forward for screening if lung cancer deaths are to lowered sufficiently enough to make such a programme worthwhile for those that judge ‘value’ in these cases.

Given that smoking cigarettes is proven to be a major cause of lung cancer, an additional challenge is how do we put in place smoking cessation programmes that dovetail with the ac-tual screening?

On the plus side, the majority of experts (and, importantly, patients when they think about it) would argue that there is a clear added value in properly run screening programmes, although this may vary - as do those oh-so-vital resources - across the 28 EU member states.

These differences in resources can also affect data collection, storage and sharing, the gene-ral delivery of healthcare, and levels of reimbursement, to name but a few.

Many plans are up for discussion but it is surely time to make some decisions, not just about screening per se but also about new, up-to-date Europe-wide recommendations.

Without doubt, all screening programmes have to be based on gathered evidence of efficacy, cost effectiveness and risk. Any new screening initiative should also factor in education, test-ing and programme management, as well as other aspects such as quality-assurance measures.

Two vital bottom-lines are that access to such screening programmes should be equitable amongst the targeted population, and that benefit can be clearly shown to outweigh any harm.

Coming up very soon is the fifth annual presidency conference organized by the European Alliance for Personalised Medicine (EAPM). The EAPM event will take place in Brussels on 27-28 March, 2017, under the auspices of the Maltese Presidency of the European Union.

Experts from all stakeholder groups in healthcare will be examining the need for more re-commendations and guidelines on health and preventative measures across the current 28 member states, affecting some 500 million EU citizens, while taking into account the counter arguments with respect of population-based screening programmes.

Interestingly, as long ago as December 2003, EU health ministers unanimously adopted a recommendation on cancer screening, which acknowledged both the significance of the burden of cancer and the evidence for effectiveness of breast, cervical and colorectal cancer screening in reducing the burden of disease.

At that point, EU guidelines updated and expanded for breast and cervical cancer screening had already been published by the Commission, while comprehensive European guidelines for quality assurance of colorectal cancer screening were being prepared.

More than thirteen years on and incidence and mortality rates of cancers still vary widely across the EU, reflecting a major health burden in various member states, often splitting large and smaller countries along with richer and poorer nations.

Europe is in dire need of a Barcelona-style comeback in this regard.

EAPM believes there needs to be concrete actions at the EU and member state levels, not least because less-than-half of examinations performed as part of screening programmes actually meet with all the stipulations of that now-ageing recommendation.

Organization-wise, member states and the EU should look to improve all aspects of scree-ning going forward. Therefore, consistent monitoring of population-based programmes should lead to feedback and modification of methods where the latter is necessary.

Yet there is much to be decided then, crucially, implemented, and there is a need for greater efforts, supported by collaboration between member states and professional, organizational and scientific support for those countries seeking to implement or improve population-based screening programmes.

The March conference is aimed at addressing such issues.

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