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  5. Lung cancer screening 

Lung cancer screening 

A lever 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 I or II, 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 already started a lung cancer screening program

There is no nationwide lung cancer screening program in EU-countries. 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.

Worldwide steps towards screening programs

Status from September 2021
Age standardized mortality
(Source: Word Health Organization, GLOBOCAN 2012 and own representation)

Click on the map to get more information about country specific screening programs

USA

Canada

UK

Germany, Italy, Netherlands - Belgium

Croatia, Hungary, Slovakia

Poland, Czech Republic

Russia

Japan

Korea

Region Taiwan

China

Australia, New Zealand

Brazil

    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

    A chance for increasing survival rates

    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 is the chance of survival. 4

    16to9_airport

    What do you think?

    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

    Reduce mortality. Reduce costs.

    Lung cancer 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:

    More information about cost effectiveness

    Persons at risk

    Who are persons at risk?

    The main external risk factors for lung cancer include6:

    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.

    Explore more

    News

    Lung cancer screenings on the verge of starting?

    Five seconds that can make the difference to survival. Because that's all it takes to perform a low-dose CT scan, one of the most efficient ways to detect lung cancer. Nevertheless, regular screenings are still not a common occurrence today.
     

    European lung cancer initiative: focus on early detection and effective treatment

    A European Commission plan aims to improve early cancer detection and treatment. Could lung cancer patients also benefit from this?

     

    #Futureshaper: A team player in innovation

    Christian Hofmann directs the innovation process for computed tomography at Siemens Healthineers. In the second part of our #Futureshaper series, you can find out how the Direct i4D solution he initiated can make the treatment of lung and liver cancer patients more precise, and why innovation only succeeds in a team.

     
    1

    https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/incidence

    RKI, Zentrum für Krebsregisterdaten; 76% in stage 3/4 in Germany, also UK

    2

    Balata, H., et al. (2021). "Analysis of the baseline performance of five UK lung cancer screening programmes." Lung Cancer 161: 136-140.

    3

    https://europeanlung.org/en/information-hub/factsheets/lung-cancer-screening/

    4

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

    5

    AAPM lung cancer screening CT protocols, V2.0 9.Sept. 2014; E.g. Huber, A., et al. Eur Radiol, published online 26.1.2016; Dose EU-JP: 0.05mSv/hr

    (e.g. Friedberg et al, 2000)

    6

    https://www.cancercenter.com/cancer-types/lung-cancer/risk-factors

    7

    https://www.cancer.org/cancer/lung-cancer/treating-small-cell/by-stage.html

    8

    National Lung Screening Trial Research Team, Aberle et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5): 395-409

    9

    Miller et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019 Sep;69(5): 363-385

    10

    Jones et al. Recent advances in the management of lung cancer. Clin Med (Lond). 2018;18(Suppl 2): 41-46

    11

    Kalchiem-Dekel et al. Multiplanar 3D fluoroscopy redefines tool-lesion relationship during robotic-assisted bronchoscopy. Respirology. 2021 Jan;26(1):120-123

    12

    Jung et al. Ten-year patient journey of stage III non-small cell lung cancer patients: A single-center, observational, retrospective study in Korea. Lung Cancer. 2020 Aug;146:112-119

    13

    Gospodarowicz. Global Access to Radiotherapy-Work in Progress. JCO Glob Oncol. 2021 Jan;7:144-145