34,000 deaths per year in Italy alone. With these figures, lung cancer represents the most frequent cause of oncological death in Italy. all this in the face of constant improvements in surgery and pharmacological therapies, which have allowed – also thanks to the primary preventionfirst and foremost the fight against smoking – to significantly increase patients’ survival expectations.
But be careful: the success of the treatments is linked to the early diagnosisThe earlier you arrive, the greater the chances of improving the prognosis. For this reason, a targeted screening program appears to be of great importance, both for the individual and for the health system. But how does screening work? And to whom is it proposed?
The RISP program, Italian Pulmonary Screening Network
Lung cancer screening is based on low-dose computed tomography (LDCT) of the chest. This test could help increase the number of early diagnoses from the current 25% to 60%, allowing patients to be candidates for less invasive surgery and treatment with innovative drugs, increasing the chances of recovery.
With an important impact also from an economic point of view, if we consider that Lung cancer costs 2.5 billion euros each yearwhich includes both direct (healthcare) and indirect (social) expenditure.
Low-dose CT represents a promising strategy. Clinical studies have shown that This approach reduces mortality in heavy smokers by 20-25%which can be translated into over 5,000 fewer deaths every year in our country.
In this sense, the Ministry of Health and the Regions have established the Italian Pulmonary Screening Network (RISP, http://www.programmarisp.it). The program was initially aimed at people aged between between 55 and 75 years oldwho have been smoking a pack of cigarettes a day for more than 30 years. Heavy smokers who have quit less than 15 years ago can also participate.
There Low-dose CT It is the most suitable tool for early diagnosis: it is effective in identifying small lesions, it is easy and quick to perform (30 seconds), it is non-invasive and does not require the use of contrast medium. Thanks to screening, it is possible to identify very small tumors, which can be treated with Minimally invasive and personalized surgeryensuring the patient a rapid functional recovery and early discharge.
Not only that. Its potential extends beyond cancer prevention, allowing early identification of other smoking-related pathologies as wellsuch as the chronic obstructive pulmonary disease and the heart disease. LDCT allows us to calculate the degree of calcification of the coronary arteries, which is directly proportional to the risk of heart attack or coronary stenosis. With lung cancer screening, therefore, we can also obtain a cardiovascular risk assessment.
How much could the screening program be worth?
According to a recent study, the implementation of a structured lung screening program appears to be of great importance. This is stated by a model developed by CREA Sanità which, for the first time – integrating and updating a previous study – also analyses the impact of innovative drugs such as immunotherapyrecently introduced and offers a economic evaluation of lung cancer screening, based on evidence of cost-effectiveness, cost-utility, and budget impact.
The results of the model estimate that the implementation of a national screening program in high-risk patients would allow, thanks to a timely diagnosis, an increase in survival of screened patients of 7.63 years compared to non-screened patients, compared to a reduction in healthcare costs of 2.3 billion eurosover a 30-year time horizon.
In financial termsan initial investment of approximately 80 million Euros should be foreseen in the first year (also linked to the organisation of the screening), which would however be more than compensated by the savings of approximately 180 million euros in the first year alone.
“The developed model demonstrates that promoting screening of the high-risk population for lung cancer is an effective and efficient public health policy which, provided it is adequately promoted and incentivized, is also sustainable from a financial point of view – explains Federico Spandonaro, Associate Professor at the University of Rome “Tor Vergata” and President of the Scientific Committee of CREA Sanità”.
Who should it be proposed to and how the prognosis changes
In parallel with the fight against smoking, it is a priority to promote access to screening for high-risk subjects, i.e. smokers or former heavy smokers over 50 years of age.
“International scientific societies and the European Commission are already moving in this direction and recommend, for these subjects, regular chest CT scans at low radiation doses, for adequate monitoring – explained Giulia Veronesi, Director of the Thoracic Robotic Surgery Program at the IRCCS San Raffaele Hospital. When lung cancer is diagnosed and treated in the early stages with surgery and drugs, it is possible to achieve 5-year survival rates around 80%. For this reason, investing in a structured lung screening program is more crucial than ever, because allows a life expectancy of over 7 years with an economic saving for the national health system”.
The model presented provides a valuable tool, if we take into account the fact that, among all tumors, lung cancer is the one with the greatest impact on society: at a global level the burden reaches 4,000 billion dollars whileIn Italy, an annual cost of 2.5 billion euros has been estimated. And in a context of limited resources for public policies, the economic aspect cannot be overlooked.
Assuming that screening is carried out every two years on the high-risk population (represented by subjects aged between 50 and 79 with heavy exposure to smoking – more than 30 pack-years), considering a time horizon of 30 years and finally adopting a response rate of 30%, the model developed estimates that It will be necessary to perform on average approximately 460,000 LD-CTs per year (approximately 360,000 at full capacity if smoking habits are not significantly changed).
The research work conducted focused on the modelling of the different possible alternative methods of screening and allows for the modification of the invited and adhering population, the screening repetition frequency and the management options for cases where the screening performed does not allow a certain diagnosis. In addition, particular attention was paid to the description of the therapeutic pathways available todayi, foreseeing the possibility of their updating over time.
