Low-Dose Computed Tomography Lung Cancer Screening Public Health and Economic Benefits

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Globally, lung cancer is the leading cause of cancer death and is frequently diagnosed at an advanced stage when the 5-year survival rate is <10%. People with lung cancer who are diagnosed early at stage I have a greatly increased 5-year survival rate of 68% to 92%. Earlier detection of lung cancer by targeted screening with low-dose computed tomography (LDCT) has the potential to decrease the overall lung cancer mortality rate and could have considerable economic, quality of life, and public health impacts.

In 2021, The Health Policy Partnership released a report on the public health benefits of lung cancer screening. The COVID-19 pandemic disrupted cancer diagnosis and treatment in 55% of the world’s countries during 2020. For lung cancer, this has been significant as COVID-19 has similar symptoms and has added to the burdens placed on respiratory healthcare services, resulting in reduced access to specialist care, diagnostic staff and computed tomography scanners, and surgical care. Lung cancer survival rates were making some progress prior to the COVID-19 pandemic, but this has likely been reversed in many countries. Targeted screening for those most at risk of lung cancer, the use of individual risk-prediction models to identify those at high risk, and rapid referral pathways for patients who present at primary care settings with lung cancer symptoms are recommended.

In the NELSON LDCT screening trial of high-risk patients, 59% of lung cancer cases in the screening arm were found in the early stage. The control population—who were not offered screening—had 14% of lung cancer cases found in the early stage. When mortality was evaluated, there was a 24% reduction in lung cancer mortality over 10 years in men. Despite concern about the risks of radiation exposure due to LDCT screening, they have been determined to be negligible through randomized clinical trials, and if they are performed under high-quality standards, false-positive results and unnecessary treatments are minimized. Cost-effectiveness ratios are comparable to other screening strategies such as those for breast, cervical, and colorectal cancers.

In addition to these direct benefits, LDCT screening can detect other diseases such as cardiovascular disease and chronic obstructive pulmonary disease in high-risk individuals. Screening can also make an impact by encouraging participants to adopt healthier lifestyles and to quit smoking. Socioeconomic health inequalities, which have led to a gap in life expectancy, can also be addressed with lung cancer screening if it is performed in an equitable manner.

The report outlines key essential steps to implementing nationwide large-scale lung cancer screening. Governmental agencies around the world will need to evaluate whether these screenings are feasible and should give clear direction for implementation using existing feasibility and pilot studies. Once that is determined, national screening protocols will need to be developed. Primary care professional involvement; high-quality, multidisciplinary lung cancer care pathways; and clear nodule management protocols will also need to be included in the development of screening protocols. The recommendations are to identify eligible high-risk populations; provide information to these populations; perform screenings; refer positive cases for diagnosis, proper interventions, treatments, and follow-ups; and report the outcomes and subsequent monitoring/program refinements.

Source

The Health Policy Partnership. Lung cancer screening: the cost of inaction report. June 2021. www.healthpolicypartnership.com//app/uploads/Lung-cancer-screening-the-cost-of-inaction.pdf. Accessed October 18, 2021.

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