Abstract
Lung cancer is the most common cancer in Poland and worldwide, and the leading cause of cancer-related deaths. Compared to the present day, the annual number of new cases of lung cancer will have increased by approximately 50%, by 2030. The overall ratio of mortality to incidence totals 0.87 and is among the highest. The five-year survival rate in Poland has recently achieved 13.4%. In 2015, lung cancer screening using low-dose computed tomography (LDCT) was introduced to routine clinical practice in the United States following the publication of the largest randomised study, The National Lung Screening Trial. The implementation of screening programmes in Poland and the rest of Europe also seems unavoidable. Due to the differences, both in the socioeconomic considerations and healthcare funding, compared to that in the United States, the current approach comes down to the awaited results of the European randomised study, NELSON. During the meeting of an expert panel at the "Torakoneptunalia 2016" conference in Jastarnia, Poland, a decision was made to summarise and publish the current data on LDCT lung cancer screening in the form of recommendations, or a position statement. The document was prepared by a team composed of a radiologist, thoracic surgeons, pulmonologists, clinical oncologists, epidemiologists, internists, health prevention specialists and pathologists. It reflects the current body of knowledge about lung cancer, its diagnosis and treatment, and provides recommendations on early detection of lung cancer using LDCT. The recommendations address the screening procedure, the requirements for the teams conducting the screening, and the requirements for radiologists, pathologists and surgeons involved in the diagnosis and treatment of patients. While awaiting the results of the NELSON study and the European position statement on lung cancer screening methodology, the multidisciplinary group of experts presents their position, laying grounds for the development of an action plan for early detection of lung cancer in the upcoming future in Poland. Primary and secondary prophylaxis are the principal ways to reduce lung cancer mortality. While smoking cessation is a task of utmost importance, it must be accompanied by an effective screening programme if the outcome of the disease is to be improved.
Highlights
Lung cancer is the most common cancer in Poland and worldwide, and the leading cause of cancer-related deaths
In an effort to standardise radiological guidelines for chest low-dose computed tomography (LDCT) and to reduce false positive results in lung cancer screening, the American College of Radiology (ACR) eventually proposed a data classification and reporting system according to Lung-RADSTM
An effective screening programme requires establishment of a qualified multidisciplinary team whose radiologists will ensure that the radiation doses are kept to the minimum, while preserving sufficient quality of the scans to be able to assess the size and morphology of any focal lesions and categorise the lesions according to Lung-RADS and/or volumetry measurements recommended by Henschke et al already in 1999 [62, 63], validated and further developed in Nelson trial [50] and UK Lung Screening (UKLS) trials [32]
Summary
The clinical manifestations of lung cancer depend on its clinical stage, histological type, tumour location and the presence of distant metastases. The increasing possibilities of treatment interventions in patients with early-stage lung cancer, which can prolong survival and improve the quality of life, have triggered the development of screening programmes aimed to detect this malignancy in groups exposed to risk factors, namely, in this case, to long and intensive smoking. While awaiting the publication of the study, European scientific societies, such as the European Society of Radiology (ESR), the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS) recommend screening as part of long-term programmes conducted in comprehensively equipped, multidisciplinary and certified centres [30, 31] Another pilot study, the UK Lung Screening (UKLS), has confirmed the possibility of detecting lung cancer while it is still in the potentially curable stage [32]. The launch of the programme should initially be restricted to centres with multidisciplinary teams experienced in conducting the types of projects and meeting the requirements of most guidelines published
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