Lung cancer, it’s time to think about national screening
As is known, the risk of lung cancer is linked to smoking. But for many who say they are inclined to participate in prevention programs, there are still too many who fear lung screening. The widespread idea is that lung cancer – the first among the big killers in oncology with 34 thousand deaths a year in Italy – is a disease with little chance of cure and that the only effective proactive action is to stop to smoke. Yet the screening programs launched so far show that it is possible to identify the disease in the initial stages, increasing the chances of cure and, ultimately, survival, up to four times as much, with values reaching 80% after five years.
The relationship of smokers with health
Telling all this today, presenting the results of a survey conducted by IQVIA for Roche Italia on the relationship with the health of smokers, were some experts gathered in Rome during the event “Let’s redefine lung cancer together: screening phobia” . The survey was an opportunity to reflect on what the barriers are today that keep smokers away from accessing lung screening programs. Because if it is true that there is still no national program today (like those launched some time ago for breast, colorectal and cervical cancer), pilot screening projects for lung cancer have existed for some time. The latest in our country is the (free) ministerial one of Risp (Italian lung screening network), which aims, thanks to the use of low-dose CT scans, to intercept cases of tumors among smokers and former smokers aged between 55 and 75 years old. “There have already been around 9,400 CT scans carried out thanks to the programme, but between recruitment and registration, around 19 thousand people have been reached – he recalled Silvia Novello, full professor of Medical Oncology at the University of Turin and President of WALCE Onlus – Good results, but not enough”. The message that cancer prevention can be done, not only primary by giving up smoking first and foremost, but also secondary, is in fact still not widespread in the population.
Secondary prevention, without forgetting primary prevention
The data collected by the survey demonstrates this, as well as demonstrating that there is ground to invest in. “50% of smokers say they pay attention to prevention and self-care and 42% undergo prevention and checks, they want to take care of themselves,” he explained Daniele Esposito, IQVIA researcher, illustrating the results of the survey: “On the other hand, however, we have also observed that smokers often fear that the only response they can receive is to stop smoking.” It emerges from the survey that we are not always aware of screening programmes, and those who know them believe that they are invasive, expensive, that they take a long time, or that in any case they would arrive too late. What is missing, and what emerges strongly from the survey – continued Esposito – is a culture of early diagnosis also for lung cancer, which goes alongside primary prevention campaigns against smoking that recognize addiction. Especially since ours is still a country of smokers: one person in four smokes, and one in five is an ex-smoker. “Italy has a truly high number of smokers in Europe and, unfortunately, also one of the highest percentages of smoking adolescent girls – continued Novello – It is essential to become aware of this issue to direct people towards conscious choices for their health , always adopting an open, transparent and non-stigmatizing approach.” Whether we are talking about primary prevention, perhaps by investing in campaigns that aim to discourage the habit of smoking before it becomes an addiction, especially in young people, or secondary, with targeted screening with low-dose spiral CT scans.
The time is ripe to implement a national screening program
Screening programs are in fact able to increase the share of patients identified in the initial phase of the disease, in approximately 80% of cases, when treatments are still effective and with less invasive interventions, with benefits in terms of survival and quality of life. life, he explained Giulia Veronesi, director of the Robotic Thoracic Surgery Program at the IRCCS San Raffaele Hospital. “Lung cancer, when diagnosed at an early stage also thanks to screening, is in fact curable with a predominantly surgical approach, but also pharmacologically depending on the stage, in the majority of patients, with 5-year survival rates of around 70-80% . As a further step forward compared to the investigation presented and discussed today, we are currently working together with a group of public health experts on a cost-effectiveness analysis that aims to propose an innovative model to estimate the economic impact of lung screening in Italy , the potential costs saved and its sustainability for the healthcare system: the results will be available throughout 2024”.
In fact, the time is now ripe to imagine extending lung screening beyond the so-called pilot projects, setting up large-scale programs, continued Veronesi. The initial goal is to recruit approximately 150 thousand patients over the course of three years. The question of funding, however, is only one of the aspects to consider: “It is also necessary to imagine the governance of the program, for example by identifying an adequate recruitment system, which perhaps includes sending letters to homes, campaigns with family doctors and specialists, and that it obviously arrives in the territory”.
