Lung cancer screening in Denmark

Systematic lung cancer screening of high-risk groups offers great potential for reducing the disease burden and mortality of lung cancer. In January 2021, a proposal was submitted to the Danish National Board of Health to introduce this screening modality in Denmark.

The proposal recommends systematic annual low-dose CT screening of high-risk groups with integrated smoking cessation intervention aimed at individuals aged 55–74 years, who are current or former smokers (>10 cigarettes/day for 30 years or >15 cigarettes/day for 25 years). “Consequently, more lung cancers can be detected in early stages of the disease which helps to decrease the numbers of late-stage cancer with a subsequent reduction in both disease-specific and overall mortality,” Dr Zaigham Saghir (University of Copenhagen, Denmark) explained. However, screening may also induce harmful effects such as false-positive findings as well as overdiagnosis. The Dutch-Belgian NELSON trial showed an excess-incidence overdiagnosis rate of 19.7%. When the follow-up was extended to 11 years post-randomisation, the excess-incidence overdiagnosis dropped to 8.9% [1]. “A lead time of 9–12 years of CT screening should be taken into account,” Dr Saghir said. He also pointed out that psychosocial consequences of CT screening have been extensively studied. “Although some potentially negative short-term effects have been observed, there were hardly any long-term effects detected.” Another consequence of systematic lung cancer screening may be the considerable number of incidental findings (either thoracic or extra-thoracic). Finally, the radiation dose should always be considered. However, the population that qualifies for annual screening is a high-risk population. Taking into account that screening carries a 0.075% increased lifetime risk of dying from cancer, the benefits of screening clearly outweigh this potential disadvantage [2].

Currently, the Danish National Board of Health and Ministry of Health are considering the proposal and possible funding of a Health Technology Assessment pilot. This pilot would serve as the first step prior to national implementation. “Important in this respect is that we should focus on screening intervals, the use of risk models including biomarkers, recruitment of hard-to-reach groups (socio-economic inequality), and the assessment of the resource burden. It is key to start small and upscale fast,” Dr Saghir emphasised [3].

1. De Koning HH, et al. N Eng J Med. 2020;382:503–513.
2. Oudkerk M, et al. Nat Rev Clin Oncol. 2021;18(3):135–151.
3. Saghir Z. The planning of lung cancer screening in Denmark. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.

 

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Posted on 17 August 202216 August 2022