Is THE BIG number one killer among all cancer diseases and, in the majority of cases, is attributable to smoking. We talk about of lung cancer, the disease for which screening would save lives: to confirm the data, just published in the New England Journal of Medicine, related to a screening program conducted in Belgium and the Netherlands which show how the mortality is reduced considerably.
The study is the study of NELSON (Nederlands–Leuvens Longkanker Screenings Onderzoek) that has involved over 15 thousand participants between the ages of 50 and 74 years of age – 84% of male current smokers or ex-smokers who had smoked more than 15 cigarettes per day for more than 25 years, or more than 10 people for over 30 years. The participants were randomly assigned to two groups: one was subjected to periodic screening with spiral Ct, low-dose and the other with no type of screening. Among men, the average adhesion at the screening was 90% and approximately 9% of the participants was also subjected to a cat extra (in addition to the screening).
The results After an observation time of ten years (until December 31, 2015), researchers have shown that the mortality for lung cancer was significantly lower in the first group subjected to screening compared with the control group: in particular, among men there has been a reduction of mortality of 24%, while among women of 33%. After ten years, the incidence of the tumor was 5,58 cases a year for every 1000 people in the screening group and 4,91 cases in the control group, and the mortality for lung cancer was 2.5 deaths per year per 1000 people (156 men) in the first group and of 3.3 deaths (206 men) in the second. In general, about 60% of all cancers of the lung, of the screening group was detected during the tests and was at an early stage (IA – IB).
The advantage of the automatic analysis These results confirm those americans of the National Lung Screening Trial, which had shown how the screening with Tac at low doses was able to reduce by 20% the mortality from lung cancer. But there are differences. “The study Nelson – explains Ugo Pastorino, director of thoracic surgery of the National Cancer Institute of Milan – provides us with extremely valuable data, even if the sample considered is not as great as that of the american study, whose participants were almost 54mila. What changes is the method used: in the case of the european study, the use of specific software has allowed for volumetric analysis of nodules, which is much more accurate than the analysis can be done by the radiologist themselves. The american firm – the precise Pastorino – was based on the measurement of the diameter of the lesion by the radiologist, but certainly, from the moment that the distinction between lesions that are potentially suspicious and injuries that are not based on growth, calculation of growth is much more accurate if you compare the two volumes and not the two diameters”. For this reason, the study Nelson, thanks to an automatic system of image analysis, produced results that are much better compared to the american study, with regard both to the reduction of false positives is the reduction of mortality.
The interval between the various screening A further difference with respect to the National Lung Screening Trial relates to the time interval between the various screening and the number of exams. “In the american study, the screening had the duration of two years, with three examinations annually, while the Dutch study was based on four assessments in the span of five and a half years: a year after the first screening, after two years and after 2.5 years. This – says Pastorino – suggests that an interval of two years between the screening is effective and there are no doubts on the fact that screening reduces mortality”. To confirm this further, there are also the data of the Italian study Mild published last year on the Annals of Oncology, which show that the mortality is reduced by as much as 40%. “In our study, ” explains the doctor – even though the population taken into account was very limited, about 4 thousand people, the length of the screening was longer, i.e. 8 years. Also, unlike the Dutch which included four moments of the screening is the same for all, in our case the interval between the various screening was the custom, decided on the basis of individual risk assessment”.
The first Italian Network for the screening of lung cancer In this regard, Italy is in the first line, within the european programme Horizon 2020, to set up the first Network of centres for the screening of lung cancer and recruit in the next two years, 10 thousand heavy smokers between 55 and 75 years. Volunteers will be entered, free of charge, in a large european study (which will see the recruitment of 24 thousand persons in all, in Italy, Holland, Germany, England, France, Spain) with the purpose to define the methods best for screening pulmonary thanks to spiral Ct low-dose radiation. The national project is led by the National Cancer Institute of Milan (INT) in collaboration with the Ministry of Health.
READ – the first Italian Network for the screening of lung cancer
“Through the first Tac – explains Pastorino – and thanks to the use of specific software, will be evaluated on the individual risk, and then the intervals between the various screening will be customized. With the Tac, in fact, we measure not only the nodules that are suspicious, but also the lung damage and, in part, the damage the cardiovascular. Thus, for subjects with a lower risk, you will be able to schedule longer intervals between one examination and another. Surely, concludes the doctor – it is an efficient program that, because of the high level of automation, will save many lives.”
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