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Lung cancer, US extends screening

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The US is preparing to extend screening for lung cancer: as early as the age of 50 and also including people less exposed to cigarette smoke than guidelines have indicated so far. Until now, annual screening has been recommended for heavy smokers (one pack per day for 30 years) and former heavy smokers (who have quit less than 15 years) between 55 and 80 years of age. Now, however, the US Preventive Services Task Force, the commission of experts that deals with prevention programs, modifies its indications and publishes the new recommendations on the Journal of the American Medical Association (Jama) along with one study on benefits and risks, summarized in a editorial. In addition to lowering the age, there is also the intention to include those who have smoked a pack a day for 20 years instead of 30 (the pack-year is a unit of measurement, here an example to calculate it).

The spiral CT scan, the screening exam

The low-dose spiral CT scan is a non-invasive instrumental examination, which detects lung nodules attributable to an early stage of lung cancer in a few minutes. Clinical studies have now shown that it can significantly reduce mortality from this cancer in heavy smokers.

Lung cancer: screening saves lives

by MARIA TERESA BRADASCIO


The eligibility criteria for carrying out this examination will be substantially expanded in the USA, set by the 2013 recommendations, criteria that had been developed on the basis of the results of the National Lung Screening Trial, one of the largest randomized clinical trials conducted by the National Institutes of Health. “Estimates tell us that screening people between the ages of 50 or 55 and 80, with smoke exposure of at least one pack a day for 20 years, leads to greater benefits,” says Jama. According to the studies more recent, in fact, by expanding the eligibility for access to the annual CT scan, the deaths from lung cancer avoided increase, as does the years of life gained. On the other hand, the risk of false positives and overdiagnosis increases but the impact these risks can be controlled: for example with artificial intelligence technologies that allow automatic and standardized detection of lung lesions.

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Lives and years saved

“Spiral CT screening is done in very few countries, while in many others it is being discussed,” he says Giorgio Scalgliotti, full professor of medical oncology at the University of Turin: “Among the open questions is the frequency of screening, which represents a problem of commitment of the health services: recommending a CT scan every two years, rather than annually, is less demanding. another evaluation that certainly must be made is the cost-effectiveness ratio. There are already cost-effectiveness studies on lung cancer screening, which are not applicable to our health system, but all preliminary studies of this type say that the amount of lives saved and years of life saved are in favor of screening ”.

Spread the culture of screening

“Today it would be important for the culture of screening to spread in Italy through clinical studies that answer these and other questions. It is the responsibility of political decision-makers not to postpone the decisions yet in the face of the possibility of arriving earlier at the diagnosis of lung cancer: with screening – remembers Scagliotti – we are able to identify the disease at an early stage in about 60-70% of cases. This means doubling the chance of survival, and it must also be said that treating diseases at an advanced stage requires many resources, much less treating them at an early stage ”.

Networking knowledge

“The conditions must be created to be able to do the tac to all those who are at risk and a system of knowledge must be put online. The evidence forces us to take a position: in the USA and in very few other countries, the position has already been taken, the test is already foreseen. Hearings are being held in the European community to include lung cancer screening among those that must be taken into consideration. Let’s not forget that we are talking about the number one killer among neoplasms: lung cancer is the leading cause of death from cancer in men and the third in women ”.

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Who does not smoke

Smoking is related to about 80% of lung cancer cases, so in 20% of cases the patients are non-smokers, and they escape screening even where CT is expected. “A study conducted in Taiwan shows that if there is a positive family history, screening over 40 has its own value. However, it is a preliminary study – concludes Scagliotti – which requires further checks. In any case, it is also necessary to do research on other causes, other than smoking, of lung cancer ”.

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