Is 20% of a loaf enough?

Abstract

Kessler1 pointed out in the editorial related to the article by Ma et al2 that the estimates of lung cancer deaths (LCDs) potentially avertable by lung cancer screening in the United States should be considered in the context of the use of primary prevention, screening, technologies, and therapy.3 We recently published an article on predictions of LCDs and all-cause deaths in Italy assuming yet-unimplemented tobacco control policies (TCPs) with or without a national lung cancer screening program designed with the same regimen adopted in the National Lung Screening Trial.4 Similar to Ma et al,2 we estimated that a lung cancer screening program implemented in 2015 in Italy with a 70% uptake would bring a 3% constant annual reduction in LCDs, with approximately 700 avertable LCDs each year. We estimated that implementing a screening program in combination with TCPs would yield 2881 and 4824 avertable LCDs in 2030 and 2040, respectively. The effect was noticeable quite soon after its introduction (5 years). Implementing TCPs alone—that is, smoking cessation treatment policies (funding treatment, setting up an active quit line, promoting counseling among health professionals) or raising cigarette taxes by 20%—would produce a steadily strengthening effect starting a few years later, from 5 to 10 years after implementation. Indeed, under cessation treatment policies, LCDs would be reduced by 8.4% in 2030 (averting 1899 deaths; 436 women and 1463 men) and by 16.1% in 2040 (averting 3754 deaths; 883 women and 2871 men). Assuming a 20% increase in cigarette taxes, LCDs would be reduced by 2% in 2030 (averting 448 deaths; 109 women and 339 men) and by 2.7% in 2040 (averting 638 deaths; 157 women and 481 men). In addition, TCPs would have a greater effect than lung cancer screening in reducing all-cause deaths, because cessation produces a reduction in deaths from causes other than lung cancer and respiratory diseases. In conclusion, an analysis of the impact of a lung cancer screening program should consider the implementation of screening in addition to TCPs and not just the screening alone. Giulia Carreras, PhD Giuseppe Gorini, MD Eugenio Paci, MD ISPO Cancer Prevention and Research Institute Florence, Italy