Astonishing results of a study into lung cancer screening: when will population screening start here?

Lung cancer is by far the deadliest type of cancer. More than 10,000 people die from it in the Netherlands every year. At the same time, there is a very clear cause: smoking. That makes screening relatively simple. After all, you don’t have to monitor the entire population. Research shows that a simple CT scan can save many lives.

In the United Kingdom, there is already a population survey for heavy smokers and people who have recently stopped smoking. Rotterdam’s Erasmus MC has started a large-scale pilot population study for which people who fall into the risk group can register.

Great success
And not without reason: American scientists come up with amazing results. For twenty years, heavy smokers from different countries were scanned annually for lung cancer. The patients whose lung cancer was detected during screening had an 81 percent survival rate after twenty years. If the diagnosis was made early in the first phase of the disease, the long-term survival rate was as high as 95 percent.

“This is the first time that long-term survival rates have been examined in people who receive annual screening for lung cancer,” says lead researcher Claudia Henschke of the Mount Sinai Medical School. “The 20-year survival rate of 81 percent is an average of all participants who developed lung cancer during the study.” This percentage is much higher than without the annual CT scans. Normally the diagnosis is only made when the patient develops complaints and is ultimately referred by the GP to the pulmonologist for lung examination.

Te late diagnose
In half of the cases, lung cancer is only discovered in stage 4. Unfortunately, there is then no cure. Screening can prevent approximately one in four people with lung cancer from dying from the disease. In the Netherlands, 10,072 people died from lung cancer in 2021. This makes it almost as deadly as colon cancer (4558 deaths), breast cancer (3121 deaths) and prostate cancer (2996 deaths) together.

Only 16 percent of lung cancer diagnoses are made in the early stages and more than half of the unlucky ones die within a year of diagnosis. New treatment methods, such as immunotherapy, can be increasingly effective in advanced stages, but the best way to fight the disease is early detection with a CT scan before symptoms appear.

Already known in 2006
Henschke and colleagues have been investigating the effectiveness of annual CT scans for lung cancer since 1992. More than 89,000 participants worldwide have undergone long-term screening. In 2006, they announced that they had achieved a ten-year survival rate of 80 percent for lung cancer patients diagnosed after a CT scan. “We are very happy to see that we have extended the survival rates we found in 2006 to a twenty-year survival rate of 81 percent,” says Henschke.

Early detection
Of the 1,257 participants diagnosed with the disease, 81 percent were still in stage 1 of the disease. This means that a very small tumor can be seen on the images, which has not yet spread to the lymph nodes. The long-term survival rate for this group of patients was as high as 87 percent. The scientists examined people who were between 50 and 80 years old at the start of the study and who had smoked a pack of cigarettes a day for at least twenty years. However, they not only studied diehard smokers, but also the lungs of people who had not smoked at all or had smoked a pack of cigarettes a day for less than ten years. “In the United States, about a quarter of all lung cancer cases are found in people who have never smoked,” Henschke said.

“Lung cancer can be cured if people can participate in an annual screening program. It is very important that participants return every year for their CT scan,” the scientist explains. The researchers recommend annual lung screening for all adults aged 50 to 80 years old, who have a smoking history of at least twenty years and who currently smoke a pack of cigarettes per day, or who have stopped smoking in the past fifteen years.

In the Netherlands
The European pilot population study into the early detection of lung cancer is currently being conducted at Erasmus MC in Rotterdam. People between 60 and 79 years old with an increased risk of lung cancer could register. Registration is now closed. In approximately eight out of a hundred participants, abnormalities are found on the CT scan that require further examination by a pulmonologist. The pilot population survey is being conducted in the Netherlands as a test in three regions. Earlier this year, Minister Ernst Kuipers (Public Health) asked the Health Council to provide advice on a population screening for lung cancer. The council aims to have a report ready by the end of the year.

Countries such as the US, China, South Korea, Poland, the Czech Republic and Croatia already have a national program in place with the aim of detecting lung cancer early. Approval has also recently been given in Great Britain for a national population screening for lung cancer. People aged 55 to 74 with a GP record including a history of smoking are invited for an annual screening.