Pilot Program for Lung Cancer Screening in the Czech Republic – Current Interim Results
Since January 1, 2022, a pilot population program for lung cancer screening has been underway in the Czech Republic. At the 7th PREVON conference in December 2023, updates on the progress as of March 31, 2023, were presented. Data for 2022 show a 4.4% detection rate of positive findings using low-dose CT in the targeted population of current or former smokers aged 55-74 years, who have so far undergone screening.
Reasons for Nationwide Lung Cancer Screening
Malignant tumors of the trachea, bronchi, and lungs are the leading cause of death from malignant diseases in the Czech Republic. The annual incidence of these malignancies per 100,000 inhabitants averaged 61.8 (79.2 in men and 44.9 in women) and mortality was 49.5 in the years 2017-2021. Only 11% of these patients are non-smokers.
The highest proportion is found in advanced stages of the disease, with only 15-20% of cases in our country caught in stages I-II. In screening programs, the detection rate can reach up to 70%, and data from the USA and Europe show a 20-24% reduction in lung cancer mortality with screening. Therefore, the European Respiratory Society (ERS) recommends implementing a nationwide screening program.
Methodology of the Pilot Screening
The pilot screening is conducted for individuals aged 55-74 years who are active or former smokers and have a history of > 20 pack-years (e.g., smoked 1 pack of cigarettes daily for at least 20 years). A general practitioner (GP) or outpatient pulmonologist (OP) indicates low-dose CT (LDCT) lung examination for individuals meeting these criteria, conducted at a comprehensive cancer center (CCC). The GP can initially refer the patient to an OP or directly to a CCC. The screening includes brief smoking cessation intervention and offers treatment for tobacco addiction. Participation in the program is voluntary and free of charge.
Patients with negative LDCT results undergo repeated screening at intervals of 1-2 years, with uncertain results leading to repeat LDCT in shorter intervals. Patients with positive results are referred to highly specialized pneumooncosurgical care centers (POCH).
Current Results
23% of GPs (n = 989) and 70% of OPs (n = 273) are involved in the pilot program. From January 1, 2022, to March 31, 2023, GPs approached 10,122 individuals, with 48.8% (4944) consenting to screening. Of these patients, 2977 were further referred to OPs. An additional 3137 individuals were primarily approached by pulmonologists.
The complete LDCT results for 2022 include 2646 individuals. A positive result was detected in 3.3% of the first LDCT exams, with 22% having uncertain results. Second LDCTs for 583 patients with unclear results revealed a positive outcome for 7.4% and uncertainty for 13.1%. Overall, 116 individuals had positive findings, representing 4.4% of all screened. Unfortunately, only 28 have records in the National Cancer Registry (NOR), highlighting the need for consistent data reporting. Of the 28 patients, 15 were diagnosed with stage I lung cancer, 1 with stage II, 6 with stage III, and 4 with stage IV (stage not specified for 2 patients). 68% of the tumors were right-sided. 17 had adenocarcinoma, 6 had squamous cell carcinoma, 2 had neuroendocrine carcinoma, and there was one case each of bronchoalveolar carcinoma, papillary adenocarcinoma, and small cell carcinoma.
From January 1, 2022, to March 31, 2023, a total of 3983 individuals underwent their first LDCT examination, with a positive result in 3%. Of 842 (21.1%) individuals with uncertain first LDCT results, 498 have undergone follow-up examinations. Most screenings were conducted in Prague (n = 1102).
Estimate for Real Practice
The estimated number of patients referred for LDCT by 1 GP over the recommended 1-2 year screening interval is based on the following calculation: The average number of patients in GP's care is 1500. With an estimated 24% aged 55-74 (360 patients), 30% current and former smokers (108 smokers), and 50% heavy smokers (> 20 pack-years), the number of individuals 1 GP may approach for lung cancer screening with LDCT is 54.
International Scope of the Program
As part of implementing lung cancer screening in the EU, the ERS organizes the SOLACE program (Strengthening the screening of lung cancer in Europe). Its goal is to implement and optimize effective lung cancer screening in EU member states. Fifteen EU countries, including the Czech Republic, are involved. One of the project's objectives is to define groups with low screening participation, which may include women, high-risk populations like patients with COPD or a history of cancer, and individuals with long travel distances to radiology centers.
Benefits of Lung Cancer Screening
This screening program can raise awareness about lung cancer and its connection with smoking, increase detections of early-stage, curable diseases, link with smoking cessation programs, and potentially offer economic savings. Surgical treatment of lung cancer is cheaper than targeted treatment for advanced stages and allows recovered patients to return to active life. Another potential benefit is the concurrent detection of other serious conditions treatable in early stages, such as pulmonary fibrosis or chronic obstructive pulmonary disease (COPD).
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Source: Koziar Vašáková M., Koudelková M. Population Pilot Program for Early Detection of Lung Cancer: Updates and Summary of the Commission’s Work. 7th PREVON Conference, Prague, December 5, 2023. Available at: https://prevon.uzis.cz/res/file/prezentace/2023-12/06-koziar-vasakova-koudelkova.pdf
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