BREATHING IN A NEW ERA

A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPE

Lung cancer is a public health issue

T

he public health domain covers awareness, prevention, screening and the role of patient input in

policy formation. All 11 countries performed highly or moderately highly in this domain—scores

are high because many indicators referred to anti-smoking legislation, which is now common in

much of Europe. However, important differences are found in matters such as screening and patient

involvement. France, Poland and the UK performed the best; other countries performed moderately

well.

Feelings of guilt often delay diagnosis

Identifying lung cancer can be challenging, as people often present with a range of non-specific

symptoms, including cough, shortness of breath, loss of weight and fatigue.^27 Symptom awareness

campaigns hold relevance not only for the public but also primary care professionals. Oncologists and

pulmonologists participating in the country workshops expressed the importance of partnering with

their primary care colleagues to raise awareness and improve early detection.

A particular challenge of lung cancer is that many sufferers may feel guilt, and so delay seeking

medical attention. Indeed, many lung cancer patients report being aware of their symptoms for varying

periods of time before seeing a clinician.^28 Insight into patients’ perspectives on their condition may

help primary care providers to recognise potential patients with lung cancer more quickly, and so speed

their referral for diagnosis and treatment.^29

Population screening shows potential but remains

controversial

Screening for disease in the general population—with a focus on high-risk groups—is often

controversial. The risks associated with population screening include subjecting people to invasive

tests, the potential for false positive results and over-diagnosis. Lung cancer is no exception.^30 However,

the prognosis for the late diagnosis of lung cancer is dismal. One-year survival for lung cancer patients

diagnosed via emergency presentation is 11% (versus 28.6% for patients identified through other

routes). Nevertheless, emergency presentation remains common; for example, this is how 38% of lung

cancer cases in England are identified.^31

Clinical trials focused on low-dose computed tomography (LDCT) screening of high-risk populations

have been conducted in Belgium and the Netherlands (the NELSON trial), the UK, and France. The use

of LDCT scans has shown a reduction in lung cancer mortality in the NELSON trial, as well as the US-

Austria Belgium Finland France Netherlands Norway Poland Romania Spain Sweden UK

Lung cancer

is a public

health issue

Low Moderately Low Moderate Moderately High High