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% . “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 .
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 .
- De Koning HH, et al. N Eng J Med. 2020;382:503–513.
- Oudkerk M, et al. Nat Rev Clin Oncol. 2021;18(3):135–151.
- Saghir Z. The planning of lung cancer screening in Denmark. Nordic Lung Congress 2022, 01–03 June, Copenhagen, Denmark.
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Table of Contents: NLC 2022
NLC 2022 Highlights Podcast
Respiratory Disease and Physical Activity
Physical activity improves asthma control
Tailored exercise needed for COPD patients
Exercise training for IPF patients is feasible but access needs to be improved
Respiratory Disease and Reproduction
Asthma increases risks around delivery
PRO-ART study: unravelling the link between asthma and subfertility
Early-onset and uncontrolled asthma: strong association with recurrent pregnancy loss
Palliative Care in Respiratory Diseases
Advance care planning
Biologics in Asthma
Severe asthma in the spotlights
Common comorbidities in severe asthma
Treatable Traits in Obstructive Airway Diseases
Targeting treatable traits allows a personalised approach to management of (severe) asthma
Challenges in Upper Airway Diseases
Exercise-induced laryngeal obstruction (EILO) is often misdiagnosed
The role of biologics in CRSwNP
The ULANC Group: working together in CRSwNP/asthma
Interstitial Lung Diseases (ILD)
Rheumatoid arthritis-associated ILD
Thoracic ultrasound: a new diagnostic imaging tool in RA-ILD?
Update on treatment of fibrotic ILD
Lung Cancer Screening in the Nordics
Lung cancer screening in Denmark
Points of interest for radiologists screening for lung cancer
E-cigarettes impose detrimental effects on health
Effects of passive vaping in COPD patients
Vaping amongst adolescents: an alarming trend
Tuberculosis and Sarcoidosis
New antigens in sarcoidosis
Detection of latent TB infection key to preventing the spread of the disease
New antigens in sarcoidosis
Fatigue syndrome in sarcoidosis