ECC 2015
Is lung cancer screening ready for implementation in Europe?
Dr Giulia Veronesi - Humanitas Research Hospital, Milan, Italy
Can you describe the highlights of your talk?
I presented an overview of the results of the trials in Europe. You know that we had some small randomised trials, one in the north of Europe, the Netherlands and Belgium, the other in Denmark and different kinds of trials in Italy. But unluckily the very small trials didn’t reach any positive result in terms of mortality reduction so in the overall group who underwent low-dose CT the mortality was similar to the control group. But the limits of these screening trials were mainly the small sample size so they were underpowered. On the contrary, low-dose CT, the national lung screening trial with low-dose CT in the US which had a large population, 50,000 individuals randomised, had positive results in terms of reduction of mortality, a 20% reduction. This is also underestimated because it was designed to reach 20% then it has been stopped so if the follow-up would have been longer and low-dose CT more than three rounds probably the effect would be more extended, like 50% mortality reduction, this is what we imagine can be the objective.
So we will have around 350,000 deaths from lung cancer in Europe. This is our estimation for annual death, all for lung cancer, so we think that the development of a large scale screening programme is an urgent need and we think that the rate of benign disease at surgery, the false positivity rate, is reduced if you use a validated diagnostic algorithm. You also can spare costs and save money if you use the risk models to select the population and define the screening interval. This is also a paper that has been presented in Denver from the pan-Canadian group in which they used this risk model to start and to develop a screening programme and the cost-effectiveness analysis was very positive. They calculated around €9,000 for each quality of life adjusted year saved. So, much lower compared to what has been calculated in the US around the NLST study.
So the conclusions were that screening is feasible and safe and reduces mortality so should be implemented in Europe.
