Are we facing a revolution in screening for lung cancer in Europe now?

Robert Pirker, Medical University of Vienna, Vienna, Austria

Lung cancer screening by low-dose computer tomography can reduce mortality of smokers or former smokers at high risk for lung cancer. The National Lung Screening Trial (NLST) demonstrated a reduction of lung cancer mortality by 20% and of overall mortality by 6.7% (NLST Research Team, NEJM 2011, 365, 395). The NELSON trial demonstrated a reduction of lung cancer mortality by 26% (De Koning H et al, abstract PL02.05, IASLC WCLC 2018). The results of both screening trials warrant implementation of lung cancer screening in Europe as recommended by several scientific societies including the European Society of Radiology and the European Respiratory Society. 

Screening programs combined with smoking cessation programs should now be implemented in certified centers with multidisciplinary expertise. Selection of the screening population should be based on a validated risk stratification approach. Standardization of CT examinations are obligatory. Volumetric measurements of suspicious lesions are done by means of computer assisted diagnosis and documented according to a structured protocol. Definition of positive findings, management of positive findings, management of suspicious changes, monitoring of false-positive results, and monitoring of radiation dose have to be clearly stated prior to implementation of screening. All screened persons will be documented anonymously in a register. A multidisciplinary expert panel should be responsible for guidance, monitoring and quality control of screening implementation. Screening programs will significantly reduce lung cancer mortality in Europe in the future.