Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

Our plain-English summary of Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe, by G. Veronesi, D.R. Baldwin, C.I. Henschke, et al (Cancers, 2020).

The study

• Authors: G. Veronesi, D.R. Baldwin, C.I. Henschke, S. Ghislandi, S. Iavicoli, M. Oudkerk, H.J. De Koning, J. Shemesh, J.K. Field, J.J. Zulueta, D. Horgan, L. Fiestas Navarrete, M.V. Infante, P. Novellis, R.L. Murray, N. Peled, C. Rampinelli, G. Rocco, W. Rzyman, G.V. Scagliotti, M.C. Tammemagi, L. Bertolaccini, N. Triphuridet, R. Yip, A. Rossi, S. Senan, G. Ferrante, K. Brain, C. van der Aalst, L. Bonomo, D. Consonni, J.P. Van Meerbeeck, P. Maisonneuve, S. Novello, A. Devaraj, Z. Saghir, G. Pelosi
• Journal: Cancers
• Published: 2020;12(6)
• Type of article: Review
• Cited by: 68 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.

In plain English

This article is a review and consensus statement, not a new study. A subgroup of the Initiative for European Lung Cancer Screening, a large group of physicians and other experts, reviewed published research on lung cancer screening with low-dose CT scans and presented it at a meeting in Milan in November 2018. The article covers who should be screened, management of lung nodules, radiation dose, treatment, smoking cessation, incidental findings such as heart artery calcification and COPD, and costs. On asbestos, it cited a 2014 estimate that 5 to 7% of newly diagnosed lung cancers were due to asbestos exposure. It stated that there is only limited evidence for screening asbestos-exposed workers, that most such studies did not estimate individual risk, and that no validated model evaluates asbestos in detail in never-smokers. Until such models exist, the authors said the 2015 Helsinki Consensus Report criteria may be adopted. No asbestos fiber types were specified. The authors concluded that low-dose CT screening is urgently needed in Europe. They recommended risk-model selection of high-risk people, annual screening for now, national programs, and further European cost-effectiveness studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of the literature with expert consensus recommendations
• Who was studied: Published studies on low-dose CT lung cancer screening, reviewed by the Initiative for European Lung Cancer Screening, an international expert group, to make recommendations for Europe
• Exposure: Mainly smoking history and age as lung cancer risk factors. Asbestos exposure is discussed in one section, with no fiber types specified. That section cites the 2015 Helsinki Consensus Report criteria for screening asbestos-exposed workers.
• Main results:
  • The authors cited a 2014 estimate (from another source) that 5 to 7% of newly diagnosed lung cancers were due to asbestos exposure
  • The authors stated that evidence supporting low-dose CT screening of asbestos-exposed persons and other exposed workers is limited
  • The authors stated that no validated risk model has evaluated asbestos variables in detail in never-smokers
  • The authors stated that the 2015 Helsinki Consensus Report criteria may be adopted for screening asbestos-exposed persons in the meantime
  • The authors considered validated questionnaires and checklists given by trained interviewers the most reliable way to identify people with significant work exposure to asbestos
  • The authors cited the NELSON trial (another study), in which screening was associated with lung cancer mortality reductions of 26% in men and 39 to 61% in women
  • The authors recommended using a risk-prediction model to select high-risk people, and annual screening for now
  • The authors stated that European cost-effectiveness studies, although heterogeneous, overall indicated favourable cost-effectiveness ratios
• The authors' conclusion: The authors concluded that low-dose CT lung cancer screening is urgently needed in Europe to diagnose lung cancer early and reduce mortality, and that pilot programs should start in different countries
• Limitations the authors state:
  • Evidence for screening asbestos-exposed workers is limited, and most such studies did not estimate individual risk
  • Reconstructing occupational history and estimating asbestos exposure precisely is difficult because people change jobs
  • The risk-model recommendation is likely to change as prediction tools are validated more extensively in Europe
  • Most biomarker studies assessed small numbers of cases, and several used samples from patients already diagnosed with lung cancer

Topics

Medical terms in this study, explained in our Lexicon: Low-Dose CT Screening, Lung Cancer.

Related studies

• Response to comment on: "Low-dose computed tomography screening for lung cancer in people with workplace exposure to asbestos" — P. Maisonneuve, S. Iavicoli, et al. (2019)
• Low-dose computed tomography screening for lung cancer and pleural mesothelioma in an asbestos-exposed population: baseline results of a prospective, nonrandomized feasibility trial--an Alpe-adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002) — G. Fasola, O. Belvedere, et al. (2007)
• Low-dose chest computed tomography screening of subjects exposed to asbestos — K. Kato, K. Gemba, et al. (2018)
• Impact of low-dose computed tomography screening on lung cancer mortality among asbestos-exposed workers — F. Barbone, F. Barbiero, et al. (2018)
• Diagnostic Performance of Ultra-Low-Dose Computed Tomography for Detecting Asbestos-Related Pleuropulmonary Diseases: Prospective Study in a Screening Setting — M. Schaal, F. Severac, et al. (2016)
• Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality — M. Silva, N. Sverzellati, et al. (2017)

Browse more research in Cancers, or return to medical research.