Lung cancer screening 

A way to reduce cancer mortality

Lung Cancer is the cancer with a very high mortality rate. Sebastian Schmidt, Head of Strategy and Medical Affairs CT at Siemens Healthineers, talks about early diagnosis and screening programs.

Watch the full video here.

Lung cancer is the #1 in cancer mortality, with 80%1 5-year-mortality. As the early stages of the disease are painless, the majority of diagnoses happen in late stages. Today, around 80% of the patients are diagnosed in stage 3/4, where only palliative treatment is possible.

Personalized screening of high risk groups with low-dose-CT is a way to significantly decrease lung cancer mortality. In current lung screening programs, around 80%2 of the patients are diagnosed in stage 1/2, which allows treating them with curative intent.

There are, however, some concerns which hinder the implementation of screening programs: (1) Radiation Dose, (2) accuracy (false positives and negatives) and (3) costs and workload for medical personnel. 

Our contribution

We as Siemens Healthineers actively address these three challenges and contribute to successfully implementing screening programs:

Radiation_Low Dose

Radiation Dose 

Radiation Dose

We provide ultra-low-dose CT technology that allows a screening examination much below the natural background radiation.

Artificial Intelligence

Accuracy

Accuracy

We provide AI tools that improve accuracy and at the same time reduce radiology workload (costs).

Cost Saving

Costs and workload

Costs and workload

We offer the ultra-low-dose technology even in the most cost-efficient CT scanners, making screening cost-effective, affordable and available to large patient populations, without compromising quality.

Screening program

SHS_DI_LungCancer_16_9

Some countries have screening programs.3 For example, the U.S. offers a lung cancer screening program, as does the United Kingdom in many locations. Croatia and Poland are also countries that are beginning implementation, and pilot projects are underway in many other countries such as Slovakia, Hungary and Germany.

Status from September 2021 

Age standardized mortality

(Source: Word Health Organization, GLOBOCAN 2012 and own representation)

  1. USA

    Screening since 2016

  2. Canada

    Ontario,

    BC started 2018

  3. UK

    Regional (30 regions)

  4. EU

    Position paper, white paper, EU cancer plan

  5. Germany

    Decision making, positive recommendation

  6. Croatia

    National program

  7. Slovakia

    Regional program

  8. Hungary

    Pilot programs

  9. Poland

    National program

  10. Russia

    Pilot (Moscow)

  11. Japan

    Regional programs (Kyoto, Nagano)

  12. South Korea

    National program

  13. Taiwan

    National program

  14. China

    Guideline, Regional & Commercial programs

  15. Australia & New Zealand

    Pilot programs

Find here some examples of lung cancer screening in selected countries

Low Dose CT scans

Lung cancer – earlier diagnosis can provide higher survival

Lung cancer – earlier diagnosis can provide higher survival

Source: http://www.cancerresearchuk.org/about-cancer/type/lung-cancer/treatment/statistics-and-outlook-for-lung-cancer

The chance of survival from lung cancer decreases the higher the cancer stage is at diagnosis. But what does this mean in concrete terms? A patient diagnosed with stage 1A lung cancer has a 5-year survival chance of about 73%. Now, for a patient with a 2B stage, the 5-year survival is only about 36%. So, the formula can be summarized simply: The earlier the cancer is found, the higher the chances of survival. 4


16to9_airport

Early detection of lung cancer, for example through screening, significantly increases the chance of survival. Is it true or false that with modern CT scanners, radiation of a scan is in the region of a few long-distance flights?

 


Lung screening is personalized

Lung screening is personalized

Compared to breast cancer screening, lung cancer screening still shows a significant difference: In mammography screening, all women over 50 are invited to breast cancer screening. In lung screening, the screening is more targeted. People who smoke more than 30 packs a year, are older than 55, and have a family history of smoking are usually invited.

Cost efficiency

Lung screening is cost-efficient, especially when compared to late-stage therapies. Many health economic studies show that "Life year paid" is below the "Willingness to pay" in the respective analyzed region. What does this mean in concrete terms? The life years gained cost relatively little compared to what was taken as the "willingness to pay" for a life year gained within the respective healthcare system. See the details here:

Learn more about cost effectiveness

Persons at risk

The main external risk factors for lung cancer include6:

Average age at diagnosis of lung cancer 71, about two out of three are diagnosed in people over age 65

Individuals with a family history of lung cancer (non-smoker) are likely to be more susceptible to the disease

Smoking is currently considered the main cause of lung cancer. In addition, passive smoking may increase the risk of lung cancer. Smoking and screening cannot be seen independently of each other, they belong together.

Quitting smoking is a long-term measure, but screening detects lung cancer at an early stage. In the UK, it was also pointed out that screening patients also stopped smoking with screening.

Chemical agents such as asbestos can lead to an increased risk of lung cancer, especially if the person is also a smoker

Radon is an invisible, radioactive gas and is one of the main causes of lung cancer

Treatment of lung cancer 

Depending on the stage and cancer type, the treatment could be e.g. surgery, chemo, radiation, immunotherapy.7

Because lung cancer is asymptomatic up to a certain stage, it is detected too late in many cases. With the introduction of lung cancer screening, it is expected that more cases are discovered in an earlier stage.8 Therefore, the current therapy mix 9 of surgery, radiation therapy and chemotherapy will probably change to less invasive and more gentle methods.10 Key-hole surgery, stereotactic radiation therapy and local ablation techniques and combinations may become more important. Intra-procedural imaging plays a paramount role to conduct such interventions safely and efficiently.

Systemic chemotherapy may become complemented with immunotherapy which is tailored to individual genetic profiles. Robotic and electromagnetic navigation systems are already investigated in interventional pulmonology.11 Given so many treatment options it is already a challenge to optimize the treatment mix and sequence for each patient.12 To increase overall survival, it is crucial that modern treatment options are available and accessible.13 Furthermore, comparative studies are conducted to balance treatment modalities of each stage and type of lung cancer.

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