By Richard Dargan
New initiatives are speeding the adoption of lung cancer screening programs in Europe, but optimized screening criteria and nodule management are needed for these programs to reach their full potential, according to Mathias Prokop, MD, PhD, from Radboud University Nijmegen in the Netherlands, who spoke Sunday.
Lung cancer is the leading cause of cancer deaths worldwide. Research has shown that early detection with low dose computed tomography (LDCT) provides a significant reduction in mortality among high-risk individuals.
Despite the evidence provided by several landmark studies, the national implementation of such programs in Europe has been slow. Of the 27 European Union (EU) member states, only Croatia has fully implemented a targeted screening program.
“All of our efforts can be accelerated way beyond what we have been doing so far,” Dr. Prokop said.
Dr. Prokop pointed to the Strengthening the Screening of Lung Cancer in Europe (SOLACE) project as a major component of those efforts. Initiated in April 2023, SOLACE brings together an extensive network of respiratory and radiology experts across 15 European countries to develop targeted recruitment strategies for underrepresented and high-risk populations.
“The SOLACE project is a multi-center group that encourages members to pick out their best practices and share them within the EU,” Dr. Prokop said.
Pilot programs in Hungary, Poland, Czechia, Germany, France and Italy are starting to produce results. In the United Kingdom, a lung cancer screening program that began as a pilot study in 2011 has expanded throughout the country. People are invited to screen by general practitioners and the National Health Service and there is a low threshold to enter the program. So far, 5,000 cancers have been detected, with 76% in their early stage.
“The idea is to have to whole country in it by 2029,” Dr. Prokop said. “It’s probably the most professional screening system that we have at the moment worldwide.”
Collaboration will be vital to increasing screening adherence while avoiding overdiagnosis and treatment, Dr. Prokop said. The European Society of Radiology (ESR) and European Respiratory Society (ERS) have been working together in recent years to develop position papers and consensus statements on lung cancer screening. A new ESR/ECR position paper supports identifying fast-growing cancers through volumetric assessments rather than using diameter. Dr. Prokop pointed out that a mere 0.43 millimeter diameter change for a 5.3 millimeter nodule would represent a 10% change in volume, while a 2-millimeter diameter change corresponds to a 100% change in volume.
“Volumetry is much more sensitive to small changes and is much more accurate for assessment of nodules,” he said.
Moving forward, optimization of screening criteria is urgently needed, Dr. Prokop said, to improve cancer detection. Combining high-throughput scanners with AI is likely to alleviate workloads, while the development of large databases will help researchers continuously evaluate the success of these programs.
“Whether we can do that with all the privacy concerns we have in Europe is a question, but that’s something we’re really striving for,” Dr. Prokop said.
Access the presentation, “Lung Cancer Screening – U.S. and International Perspectives and Directions – European Perspective: Current Status and Directions,” (S2-CCH01) on demand at RSNA.org/MeetingCentral.
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The RSNA 2024 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, December 1 — Friday, December 6.
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