BREATHING IN A NEW ERA
A COMPARATIVE ANALYSIS OF LUNG CANCER POLICIES ACROSS EUROPEbased National Lung Screening Trial, the International Early Lung Cancer Programme and a pilot study
in Manchester in the UK (Box 1). Interestingly, despite clinical trials having been conducted, neither
Belgium, France nor the UK discuss screening programmes in their guidelines. An increase in the range
of treatment options for lung cancer has led some to re-examine their approach to screening. National
debates on screening are largely fuelled, however, by concerns over staffing challenges, how to cope
with an increase in the number of new diagnoses, and worries over radiation dosage, over-diagnosis
and cost-effectiveness.
Still lighting up: Europe smokes more than anywhere else
Tobacco is recognised as the most important risk factor for all cancers, responsible for approximately
22% of cancer deaths and 85% of lung cancer cases.37,38,39 The “tobacco epidemic”, as it has been called
by the World Health Organization (WHO), ranks as one of the largest challenges to global public
health. Worldwide, it has been estimated that 1.3 billion people currently use tobacco products—
approximately 1 billion men and 250 million women.^40 Europe has the highest prevalence of tobacco
smoking among adults (Table 2) and some of the highest prevalence of tobacco use by adolescents;
in the Czech Republic, tobacco use in adolescents is similar to that in adults.41,42 The cost of this
tobacco epidemic is immense: the annual social and economic costs directly attributable to tobacco
consumption within the EU were estimated to be €363 billion in 2012, equivalent to 3.4% of EU27 GDP.^43
Of this, the highest cost directly attributable to smoking is cancer, particularly lung cancer.^43
Box 1
NELSON study
The NELSON study^32 is the largest European
randomised controlled trial to demonstrate a
reduction in lung cancer mortality with computed
tomography (CT) screening in people at high-risk
for the disease. Individuals were recruited from
population-based registries in Belgium and the
Netherlands. The study compared groups that
offered screening with CT with those not screened.
Subjects were followed for ten years.National Lung Screening Trial
The National Lung Screening Trial^33 is a United
States-based clinical trial supported by the
National Cancer Institute and conducted by the
American College of Radiology Imaging Network
and Lung Screening Study Group.International Early Lung Cancer Action
Programme
The International Early Lung Cancer Action
Programme^34 grew out of the benefits stemming
from the Early Lung Cancer Action Programme^35
which started in New York in 1992 studying the
benefit of annual CT screening for lung cancer.
The New York study demonstrated that CT
screening identified a high proportion of lung
cancer in Stage 1.Manchester’s Lung Health Check
The North Manchester pilot^36 quadrupled the rate
of early diagnosis for lung cancer in Manchester,
UK. In March 2019 it was expanded into a four-year,
ten-site intervention targeting those at high-risk
for lung cancer. CT scans will take place in mobile
units or in hospitals.