Lung cancer doesn't have to be a death sentence

Recent developments in lung cancer screening have brought the topic of prevention into new focus. Sebastian Schmidt, MD, Head of Strategy, Innovation and Medical Affairs, Siemens Healthineers gives more insights. 

Kathrin Palder
Published on 13. Dezember 2022

Sebastian Schmidt

<p>First of all, this decision is highly welcome. Lung cancer is the deadliest type of cancer worldwide. In the 27 countries of the European Union alone, lung cancer results in 240,000 deaths annually.<sup>1</sup> This corresponds to 650 deaths per day, or to put it more dramatically, the equivalent of two plane crashes. That is why it is important that political stakeholders are taking action. The EU recommendation marks a crucial milestone, and we hope that more countries follow the lead of Poland and Croatia who have already started local lung cancer screening programs.</p>
<p>In fact, the average five-year survival rate for lung cancer worldwide stands at only 20 percent.<sup>2</sup> Because the lungs have no pain receptors, lung cancer usually remains symptom free for a long time. By the time those affected complain of symptoms such as breathing difficulty or are coughing up blood, the disease is usually far advanced, and in stage III or IV, curative therapy is for all intents and purposes nearly impossible. In stage IV the five-year survival rate drops to around five percent.<sup>3</sup> This means that after five years only one in 20 of those affected are still alive.</p>
<p>The good news is – and we have the numbers to back this up – lung cancer does not have to be a death sentence. The earlier the disease can be diagnosed, the better is the prognosis for the patient. When we look at the USA and their well-established national screening program as well as regional pilot programs in the UK, we see reliable data that emphasizes the benefit of screening for the early detection of lung cancer in active and former smokers. Early detection means at a stage when the cancer can be treated with curative intent which in turn decreases lung cancer mortality.&nbsp;</p><p>In the US, where a national screening program was rolled out eight years ago, it has been estimated that more than 10,000 untimely deaths from lung cancer were prevented between 2014 and 2018<sup></sup>.<sup>4</sup> A look at the US Cancer Registry shows what is referred to as a Stage Shift, which means there are more diagnoses in Stages I and II and fewer diagnoses in Stages III and IV in the long term. England, which has had screening on a regional level since 2018, is seeing similar success. Almost three-fourths of patients to date have been diagnosed in Stage I or II.</p>
<p>Smoking cessation (also called primary prevention) and screening always have to go hand in hand in order to successfully reduce the high mortality rate of lung cancer. As studies from England have already shown, the two work well together: The success rate for smoking cessation with screening is almost double that without screening. Of course, the goal is that as few people as possible smoke. But in addition, screening is needed because it has an immediate effect since lung tumors can be found at an early stage and the patient can undergo curative surgery. Smoking cessation in contrast is long term; even if young smokers were to stop from one day to the next, the positive impact on lung cancer statistics would not be seen for 30 to 40 years. In the long term, screening could even be seen as a means of cost reduction, because at an earlier stage patients can undergo less expensive minimally invasive surgery instead of being treated with expensive medications at later stages with only limited chances of success.</p>
For one, through ongoing development in the field of Computed Tomography, which is the imaging method of choice assisting the physician in diagnosing lung cancer towards improving image quality at the lowest possible dose. One year ago, we introduced NAEOTOM Alpha<sup>5</sup>, the world's first photon-counting CT scanner. It provides drastic improvements, including higher resolution and up to 45 percent less radiation dose with ultra-high resolution (UHR) scans, compared with conventional CT detectors with a UHR comb filter. Additionally, we want to tap further into the opportunities presented by Artificial Intelligence (AI).
<p>AI plays a critical role as a second opinion in diagnostic assessment, especially since the number of examinations continues to increase, a trend that will further accelerate when screenings become widespread. At the same time, there is a lack of radiologists and radiology professionals and unfortunately, reduced time for diagnostic assessment also increases the susceptibility to errors. AI can help in obtaining more precise and faster results.</p>
AI Rad Companion Chest for Lung Cancer
<p>AI can help in obtaining more precise and faster results. In terms of AI, Siemens Healthineers offers the AI-Rad Companion Chest CT<sup>6</sup>, which highlights abnormalities. It helps radiologists interpret CT images of the thorax and can help draw their attention to certain areas. In addition to concrete support in diagnostic assessment, AI in combination with medical imaging can do much more. For example, image artifacts that occur when the patient breathes during a CT examination can be reduced using artificial intelligence: A special sequence from Siemens Healthineers calculates patient movements and triggers the acquisition of computed tomography images at the exact moment when the conditions for the best possible image quality are optimal.</p>
<p>Naturally, there is fear of radiation, which is understandable since screening also means exposing generally healthy people to radiation. However, with low-dose CT, we are talking doses in the range of conventional radiographic imaging, just imagine an X-ray image that is being taken after breaking a bone. Take Germany as an example, where it has already been decided that a lung cancer screening examination must not exceed 1.3 milligrays (CTDI) which is less than the natural radiation exposure in the country. Of course, it is also important to keep the number of false positive findings as low as possible so that people have trust the screening. The numbers from England in this regard are encouraging. An analysis of the first 10,000 screening participants showed that 98 percent had a correct positive lung cancer diagnosis. Only two percent were false positive.<sup>7</sup> And lastly, it is important to create awareness for lung cancer and why an early diagnosis is crucial: Detected early in Stages I or II, it can be treated using minimally invasive surgery with curative intent. As I previously stated: lung cancer does not have to be a death sentence.</p>

By Kathrin Palder

Kathrin Palder is an editor at Siemens Healthineers.