SHOULD have left a year and a half ago. Then came the pandemic. We are talking about lung cancer screening in heavy smokers, with low-dose radiation CT scan: an early diagnosis pilot project that, according to experts, could halve mortality from this disease in the next twenty years. And now we are back in the starting blocks. The Budget Commission of the Chamber has in fact approved an amendment to the Sostegni bis decree which allocates 1 million euros per year for the Italian Pulmonary Screening Network which was to be established in 2020. “This is a fundamental support for developing a prevention throughout Italy, because it not only gives economic tools but recognizes the need for a prevention program ”, he says Ugo Pastorino, Director of the Complex Structure of Thoracic Surgery of the National Cancer Institute of Milan, one of the promoters of the experiment.
Lung cancer: screening saves lives
by MARIA TERESA BRADASCIO
10 thousand volunteers, to begin with
A coordinated program can therefore be started again to launch the pilot study that will involve 10,000 people, to demonstrate that lung cancer screening is possible at sustainable costs and that it is cost-effective over the years. “We estimate that every year screening for lung cancer in heavy smokers could involve around 500-600 thousand people: therefore 10 thousand is a small number in proportion, but it is very important to demonstrate in practice that the strategy is sustainable and effective. ”, Explains Pastorino. Today the percentage of lung cancers discovered when they are still operable and potentially curable is 20-25%: with screening it is expected that it will double. “The cost of treating advanced disease is very high – continues the surgeon – and unfortunately the results are still poor even with the most modern and expensive drugs. Screening would make it possible to save 10-15 thousand lives a year, therefore a very important objective, with a relatively low cost “.
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The next steps
Realistically, the project could really start in January 2022, Covid permitting. The next steps are the definitive approval, the publication of the implementing decree with the map of the first accredited centers: “There are many centers with latest generation CT scans and there is no shortage of radiologists capable of providing an excellent level of competence”, he continues. ‘expert: “Therefore, an investment in technologies will not be necessary: the most important thing is to do training immediately: if you start from scratch, the risk of making mistakes and increasing the sense of distrust that comes from false diagnoses is high. For this reason, the project envisages training and the possibility of relying on a second radiologist for a centralized reading of the images, to provide an orientation criterion “. In fact, in the CT scan of a heavy smoker, many lung lesions are identified, but the significant ones are few. In 20 years of experience, we now know that it is possible to separate well the few important lesions from the myriad of non-pathological lesions, thanks to the artificial intelligence and the reading of an expert radiologist, minimizing the recalls.
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The aim is to offer a service that is close to people and free of charge
Another fundamental aspect: the people who participate in the screening should not travel more than 100 km to take the exam, and this, with the geographic conformation of Italy, is not always easy. “What we want to create is also a model of territorial medicine”, emphasizes Pastorino: “Participants should not incur any costs for the exam and spend little for travel. We are talking about people who are generally very negative about the future: fatalists, who are afraid of contact with a health facility when there is no immediate need, and think that there is little to do for those who have smoked for a long time. Unfortunately, some doctors also think so, but it is not necessarily true ”.
The role of general practitioners
Another objective of the program is to involve general practitioners: “They have a fundamental role in identifying and convincing their patients most at risk, because we cannot rely only on self-selection and individual will. But also to evaluate the positive consequences of screening ”, concludes Pastorino:“ This project can be an example of a good teamwork of specialist and territorial medicine ”.
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