by Vera Martinella
Volunteers participating in the project receive free support to say goodbye to tobacco and cytisine tablets, as well as a periodic spiral CAT scan that monitors the health of the respiratory system and heart
In 18 Italian hospitals it is possible to have a free exam which discovers the possible presence of lung cancer before the symptoms appear, which in most cases appear when the disease is already in an advanced stage. And at the same time smokers are being helped to quit: a good resolution for the summer, given the warm season and the holidays, they make available a few more weapons to those who want to give it a try. In fact, there are still places available to participate free of charge in the RISP program (Rete Italiana Screening Pulmonare, the first lung cancer screening program), launched about a year ago aimed at women and men between 55 and 75 years old, strong current smokers or former smokers for less than 15 years.
Who can participate
You can apply by registering on the portal www.programmarisp.it and indicating the center closest to the place of residence – explains Ugo Pastorino, director of the Complex Structure of Thoracic Surgery at the National Cancer Institute of Milan (INT) and coordinator of the RISP program -. The recruitment is open to smokers with an average consumption of 20 cigarettes a day for 30 years, or former heavy smokers who have quit for less than 15 years, aged between 55 and 75. The participants will be periodically monitored with low-dose computed tomography of the chest (the so-called spiral CT scan) a simple assessment: it lasts a few seconds, without contrast medium and with a very limited dose of radiation, which can identify small and localized nodules, allowing to intervene in a timely manner, thus reducing deaths from cancer. Furthermore, with this exam the participants will not keep a potential tumor under control, but also respiratory and cardiac pathologies.
Cytisine, the drug that helps you quit smoking
If discovering a carcinoma in the initial stage can save life (the smaller the nodule, the more minimally invasive and radical surgery can be, with high chances of definitive recovery), it is equally crucial to provide support to help smokers quit: very few Italians they resort to drugs useful for cessation of addiction and also those who turn to expert personnel who can make an identikit of the smoker and support him in his decision to say enough. But statistics indicate that if you ask for help, your chances of succeeding increase. Thus, as part of the RISP programme, the Milanese INT promoted the distribution of cytisine to the 18 centers participating in the project.
This drug, until now only available in a galenic formulation, is now in specially prepared tablets, currently only for administration to study participants. Cytisine is an anti-smoking drug with many advantages, as demonstrated by a study conducted by INT together with the Mario Negri Institute in Milan and the University of Parma. an active ingredient that is well tolerated, almost free of side effects and which, unlike nicotine, does not create addiction – comments Roberto Boffi, head of Pneumology and the INT Anti-Smoking Center -. It has a dosage scheme that provides for a 40-day therapy, with smoking cessation scheduled between the eighth and 14th day, divided into several daily intakes due to the short half-life of the active ingredient. This limit, however, can also be its trump card because it replaces the ritual of the cigarette.
Reduce lung cancer deaths
Every day in Italy about 115 people discover they have lung cancer (for a total of almost 44 thousand new cases registered in 2022), which remains a fearsome big killer because more than 70% of patients arrive at diagnosis late, when the disease is already in an advanced stage and unfortunately the chances of healing are reduced. The neoplasm, in fact, does not show evident signs of its presence at the outset and when it does it is generally already progressed in the metastatic phase. Approximately 85% of patients were either tobacco users: the aim is to demonstrate that it is possible to reduce lung cancer mortality in high-risk heavy smokers thanks to low-dose computed tomography screening for early diagnosis and with a process of smoking cessation that also includes cytisine – says Pastorino -. And if the data we obtain confirm our hypotheses, the next step will be to stimulate the institutions to include this approach in the essential levels of assistance, thus making both the low-dose CT scan and the anti-smoking drugs reimbursable with the National Health Service. preventive purpose for those who are at high risk.
The Centers where it is possible to participate
The RISP program is developed in the context of a randomized multicenter study funded by the Ministry of Health and active in 18 selected centers distributed in 15 Regions (Lombardy, Liguria, Lazio, Veneto, Abruzzo, Basilicata, Calabria, Campania, Emilia Romagna, Marche, Autonomous Province of Trento, Piedmont, Puglia, Tuscany, Sicily).
The added value: CT with artificial intelligence
The RISP Program provides for the execution of the thoracic spiral CT scan at low exposure doses, in line with the results of the latest studies conducted in the USA, Europe and Italy. All have demonstrated its effectiveness in the early diagnosis of lung cancer. We analyze the results of the CT with the support of artificial intelligence which allows us to reduce false positives and, consequently, surgical interventions for benign pathologies – clarifies Nicola Sverzellati, director of the Radiological Sciences Unit in Parma and Full Professor in the Department of Medicine and Surgery of the University of Parma -. We also use state-of-the-art equipment which is extremely quick to perform and, more importantly, exposure to a minimal dose of radiation, without compromising the quality of the images. The chest CT scan also provides many other useful information on the health of the heart and lungs and helps to evaluate any other damages to promptly catch other pathologies caused by smoking.
The diagnosis of lung cancer, also a gender issue
Lung cancer is now the second most common malignancy in men and the third most common in women. We are witnessing an increase in cases of disease among the female population – underlines Silvia Novello, head of Pulmonary Oncology at San Luigi Gonzaga in Orbassano and president of WALCE Onlus – Women Against Lung Cancer -. The one and only cause of this figure is the increase in the habit of smoking. What we are also noticing is that one in ten women starts before the age of 15. In Europe, Italy stands out for one of the highest rates of young smokers, a sad record that we would rather not have. For this reason, it is necessary to think of prevention campaigns aimed at different segments of the population: one cannot think of raising awareness with the same messages and strategies for 11-year-old girls and women over 50, also because in the latter case the objectives become two , screening and prevention.
A big killer, but you can heal
Unfortunately, only about 18% of patients are alive five years after the discovery of the disease, even though scientific research has made important progress in recent years. Thanks to screening, it is possible to receive a diagnosis at an early stage, that is, when the tumor is in the first and second stage and there is a concrete possibility of healing – recalls Francesco Facciolo, director of Thoracic Surgery at the Regina Elena Institute in Rome -. In these cases the tumor is curable with a simple, decisive intervention performed in minimally invasive surgery, with a long-term survival of more than 80%. The smaller the nodule when it is identified, the more minimally invasive and radical the surgery can be, with high chances of definitive healing.
The RISP Program provides for the recruitment of 10,000 volunteers over an 18-month period. Currently, the adhesion is 50%, but to inform the population in a capillary way, we have involved about 300 pharmacies scattered throughout the Apulian territory and also thanks to this strategy we have managed to record a high adhesion – concludes Domenico Galetta, head of Oncology medicine for thoracic pathology at the John Paul II Cancer Institute in Bari -. The smoker who recognizes himself in the characteristics indicated by the program can enroll in the pharmacy and also make an appointment for the CT screening. The other positive aspect is that in half of the cases, people also asked to participate in the process of cessation with a high percentage of success.
July 14, 2023 (change July 14, 2023 | 09:14)
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