The Italian Pulmonary Screening Network (Risp) is launched, which will put 7300 smokers under the lens with the aim of finding lung cancer as soon as possible thanks to low-dose computed tomography of the chest. The project was presented today in a press conference at the XXIV Aiom National Congress (Italian Association of Medical Oncology), which opens today in Rome.
Salute
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by Fabio Di Todaro
Lung cancer numbers
Lung cancer is responsible for the largest number of cancer deaths in Italy, 34,000 in 2021. Approximately 60%, equal to 20,400 deaths, concerns heavy smokers. “These are alarming numbers that require us to act as soon as possible against what remains the big killer – he says Saverio Cinieri, national president of Aiom (Italian Association of Medical Oncology). The main culprit is smoking and the addiction it creates. “In our country – he explains Silvia Novello, Professor of Medical Oncology at the University of Turin and Head of Pulmonary Oncology at the San Luigi Gonzaga Hospital in Orbassano – there are about 12 million smokers, 20% consume more than 20 cigarettes a day. Within RISP, secondary prevention is combined with primary prevention and smoking cessation programs are offered. The two strategies must travel in pairs, because only in this way can we really act on the incidence and mortality rates of this disease ”.
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The identikit of the candidate for the Resp
Who can participate in the RISP ministerial program (Italian Network Pulmonary Screening Project?) The ideal candidate is between the ages of 55 and 75, has been smoking a pack of cigarettes a day for more than 30 years or is a heavy smoker who has quit for less The recruitment begins these days, with the aim of involving over 7300 people (7324), periodically monitoring them with low-dose computed tomography (LDCT). “There are 18 centers with high multidisciplinary clinical competence distributed throughout the national territory that fall within the RISP – he clarifies Novello, Professor of Medical Oncology at the University of Turin and Head of Pulmonary Oncology at the San Luigi Gonzaga Hospital in Orbassano. “In heavy or former smokers, the availability of periodic screening represents absolutely an opportunity, potentially guaranteeing the early detection of the disease and therefore its timely management with greater possibilities of treatment and recovery”. People who have the required characteristics can participate in the RISP program through different channels: from the web (by registering on the portal www.programmarisp.it and indicating the center closest to the place of residence) to oncologies, pneumologies and cardiologies involved in the recruitment.
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The advantages of the low dose spiral tac
Every year, in Italy, 32,800 citizens (about 80% of cases) are diagnosed with advanced lung cancer, when the disease is not operable and the prognosis is worse. Clinical studies have shown that the use of low-dose spiral CT scan can reduce mortality from this neoplasm in heavy smokers by about 20%. This is a pilot project, the first of its kind in Italy, launched to lay the foundations for the inclusion of lung screening within the Essential Levels of Assistance (LEA), like secondary prevention programs for breast cancer, colorectal and cervical. “With the low-dose spiral CT scan, an exam that lasts a few seconds, we can also photograph the global risk for other smoking-related diseases, quantifying for example the coronary damage or the emphysematous share”, he emphasizes. Rita Chiarimember of the National Board of Aiom and Director of Oncology of the Hospital of the Ospedali Riuniti Marche Nord.
The first step towards structured screening programs
Low-dose CT is a promising life-saving strategy, but unfortunately, to date, it is not yet part of clinical practice and secondary prevention programs reimbursed by the National Health Service. “We hope – emphasizes Cinieri – that RISP will contribute to a cultural change. The European Commission, a few days ago, launched a new initiative aimed at strengthening prevention and facilitating the early diagnosis of cancer. One of the diseases for which an intensification of preventive checks is foreseen is lung cancer and the European Union will issue an ad hoc directive in the coming months. National health systems will be called upon to actively participate in launching structured screening programs for lung cancer in individuals at risk. RISP represents the first step in this direction ”.
The economic impact of the disease
The economic impact of the disease should not be underestimated, which in our country amounts to about 2.5 billion euros every year, considering both the direct health costs and the indirect and social costs. “Anticipating the diagnosis, thanks to screening – continues President Cinieri – means increasing the number of people who can return to work, reducing socio-economic costs due to lost productivity and guaranteeing savings to the system thanks to fewer hospitalizations”. It is estimated that the candidate population for lung screening with low-dose CT scan, according to international guidelines, is between 600,000 and 800,000 citizens in our country. “Screening is one of the most precious public health resources and becomes crucial in the oncology field, where modifying the natural history of the disease means identifying it at the earliest stage – underlines Rita Chiari, member of the National Board of AIOM and Director of Oncology of the Ospedali Riuniti Marche Nord hospital. “The number of lives saved can become really significant with the spread of lung screening on a large scale. Furthermore, studies conducted in Italy show that it is possible to customize the screening according to the individual risk level, reducing the number of low-dose spiral CT examinations, without affecting the benefits associated with this approach. A personalized screening protocol would have a less severe economic impact, both at the instrumental level and in terms of the commitment required of the radiological personnel involved “.
Institutional support
In 2020, about 41,000 new lung cancer diagnoses were estimated in Italy. The 5-year survival is 16% in men and 23% in women. “Similar experiences have already been started at the European level, the uniqueness of RISP is that it is achieved thanks to the allocation of ministerial funds – says Novello. With the Sostegni-bis Decree Law, in fact, 2 million euros were disbursed for the two-year period 2021-2022 to support the program. Screening can facilitate the early identification of cancer, increasing the number of patients eligible for surgical resection and guaranteeing them access to treatment with the most innovative drugs. Targeted therapies and immunoncology, which have already improved survival in advanced and metastatic disease, can play an increasingly important role even in the early stages “. The Risp program is also implemented thanks to the support of AstraZeneca. “We are founding members of the Lung Ambition Alliance, a partnership between organizations, including the International Association for the Study of Lung Cancer (IASLC), Guardant Health and the Global Lung Cancer Coalition (GLCC), with the aim of improving the condition of people with lung cancer ”, he concludes Mirko Merletti, vice-president of Oncology AstraZeneca. “As part of the Lung Ambition Alliance, AstraZeneca’s commitment takes shape in Italy in various projects, including the PolmoniAMO Manifesto, a document drawn up by clinicians to raise awareness among citizens and institutions on the importance of early diagnosis, and support for programs like the RISP “.