What did the first data from the pilot lung cancer screening show?
Czech pulmonologists have released the first interim results of this year's pilot testing of heavy smokers due to the risk of lung cancer. More than 4,000 patients passed through the hands of general practitioners, and 900 subsequently underwent low-dose CT examination. What other specific findings emerge from the data collection? And what challenges do the experts involved in this program face?
How does the pilot program work in practice?
The pilot project was launched in January this year and is intended for former and current smokers aged 55–74 who have a history of 20 or more so-called pack-years (years spent smoking, with at least one pack of cigarettes smoked per day).
The program algorithm is set so that selected individuals are contacted by general practitioners and referred to an outpatient pulmonologist who performs basic lung examinations. The pulmonologist then usually refers them to a radiologist, ideally at pneumooncosurgery centers, where they are examined using low-dose CT. In the case of a positive result, further examinations are conducted, and the patient is indicated for surgical treatment. The aim of the program is to detect the tumor at an early, operable stage.
What are the current results and why do some "fall through the cracks"?
According to data from the National Register of Paid Health Services (NRPHS) from October this year, general practitioners contacted 4,183 smokers in the first two quarters of 2022. Of these, 2,039 individuals (just under 49%) were further referred to a pulmonologist, while the remaining 2,144 refused to participate in the project. The next step, low-dose CT examination at radiological workplaces, involved 900 individuals, of whom 891 had valid results: 606 (68%) were negative, 244 (27%) had an indeterminate record (thus requiring a CT repeat), and 41 patients (just under 5%) were positive. These are referred to a pneumooncosurgery center where further diagnostics, including bronchoscopy, are carried out, and if positivity is confirmed, they are indicated for surgery.
And why do more identified at-risk individuals not undergo screening? “Some patients refuse to go for further examinations, while others have simply not yet gone. Additionally, pulmonologists are forced to exclude some individuals from the preventive program due to their current health status, which limits life expectancy or the ability to perform surgical tumor removal. For example, individuals with advanced stages of chronic obstructive pulmonary disease or large-scale generalized tumors are not recommended for low-dose CT. This also applies to patients with other serious diseases, such as heart failure, severe dementia, and the like,” explains MUDr. Ivana Čierná Peterová, chairwoman of the outpatient pulmonologists section of the Czech Pulmonology and Phthisiology Society ČLS JEP.
A race against time in both diagnostics…
The primary goal of the preventive program is to detect potential lung cancer at an early stage, which is treatable surgically. This modality is cheaper and also allows for complete patient recovery. Therefore, it is important that both the diagnosis and subsequent therapy proceed quickly.
According to docent MUDr. Milan Sova, Ph.D., chairman of the Czech Alliance against Chronic Respiratory Diseases, the transition through the system from the first contact with the general practitioner to the delivery of the diagnosis should not take more than two months, ideally even shorter. “Our aim within the society is to try not to exceed one month. This is very ambitious since, for example, obtaining histological examination results takes some time,” notes docent Sova, adding that this goal is somewhat more achievable for pneumooncosurgery centers. According to him, the speed of the process further depends on regional capacities and the approach of the doctors themselves. “It is important that all pulmonologists are aware of the concept of pneumooncosurgery centers, where processes should be standardized, automated, and accelerated to prevent patients from getting lost in the system. Patients themselves should also be familiar with the system,” he adds.
… and in treatment
The next step is timely indication and initiation of treatment. For this purpose, the recently created pneumooncosurgery multidisciplinary MDT board, which includes specialists across fields from the General University Hospital in Prague, Motol University Hospital, and the Central Military Hospital, should help. The aim of this expert group is to provide the best available treatment for patients with lung tumors and other lung diseases or pathologies in the chest area, and to significantly shorten the interval from diagnosis to treatment initiation. Through regular indication seminars held online, board members provide consultations to pulmonologists, thoracic surgeons, or oncologists regarding the treatment approach for specific patients.
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Sources:
1. Press conference of the Czech Pulmonology and Phthisiology Society ČLS JEP (ČPFS), Czech Alliance against Chronic Respiratory Diseases (ČARO), and Czech Civic Society against Pulmonary Diseases (ČOPN), Prague, November 15, 2022.
2. Lung cancer screening program. Czech Oncological Society ČLS JEP, 2022. Available at: www.linkos.cz/onkologicka-prevence/screening/program-screeningu-karcinomu-plic
3. Cooperative Thoracic Group. MDT Board. Available at: https://mdtboard.cz
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