Still, about 45,000 Germans die annually from lung cancer due to late detection. This is set to change now. Scientists, with DZL involvement, have outlined the key points of a national early detection program that can significantly reduce mortality risk, especially for long-term smokers. "We provide treating physicians and health policymakers with clearly defined recommendations for a unified, structured, quality-assured early detection program that is effective, safe, and cost-efficient," says Professor Torsten Blum, one of the three lead authors of the position paper presented.
Over the course of a year, experts from the German Respiratory Society (DGP), the German Radiological Society (DRG), and the German Society of Thoracic Surgery (DGT) have worked on this initiative together. "At the same time, we caution against the real dangers of unstructured and inadequately coordinated screening measures, as this could lead to unnecessary vulnerabilities and sources of error along the entire process chain," adds pulmonologist Blum, Senior Physician at the Department of Pneumology, Helios Klinikum Emil von Behring in Berlin.
The ordinance required for the application of computed tomography screening by the responsible Federal Ministry for the Environment, Nature Conservation, Nuclear Safety, and Consumer Protection could come into force as early as the turn of the year. Subsequently, the Joint Federal Committee (G-BA), which decides on the entitlement to benefits for people covered by statutory health insurance, will have 18 months to develop the necessary directive. "While an unstructured lung cancer screening without specific guideline requirements may be possible as early as the beginning of the year, a structured program will only be possible with the decisions of the G-BA," explains Professor Hans Hoffmann, thoracic surgeon and the second lead author of the position paper. "As clinicians, we naturally wish for timely good guidelines for a structured lung cancer screening program in Germany, as it will save lives. But we also understand the work and responsibility that comes with it for the G-BA. On behalf of the professional societies involved in lung cancer screening, we support the responsible Federal Committee in its work because we all want an effective and safe national program," adds the Head of the Section for Thoracic Surgery at the Klinikum rechts der Isar in Munich and Chairman of the Certification Commission for Lung Cancer Centers of the German Cancer Society.
Although the benefits and safety of lung cancer screenings are scientifically undisputed, it is important to continue to highlight the dangers until the G-BA directive is available. The message here is clear: Low participation rates as well as high rates of overdiagnosis or false-positive findings jeopardize the early detection goals but can be avoided through clear structural guidelines. "In the context of our HANSE study on lung cancer early detection conducted at three clinic sites in northern Germany, we were able to show that a structured lung cancer screening program is well integrable and feasible within the existing healthcare system," points out radiologist Professor Jens Vogel-Claussen. The DZL researcher is Head of the HANSE study and the third lead author of the new position paper. "Implementing our recommendations will lead to effective and safe lung cancer screening in Germany. But even in the future, the involvement of professional societies will be important to jointly further develop a national program based on new research findings," adds the Senior Consultant at the Institute for Diagnostic and Interventional Radiology, Hannover Medical School.
Specifically, the lung cancer early detection program is intended for people aged 50 to 75 years who have smoked for at least 25 years or whose smoking cessation is less than ten years ago. Screening should also be made available to individuals with at least 15 pack-years - meaning those who have smoked one pack per day for 15 years, for example. This would affect a total of about 3.3 million men and approximately 2.2 million women in Germany, according to the experts. The annual screening will be coordinated by a central authority. The lung cancer screening itself will be performed using low-dose computed tomography. "Lung cancer early detection within a well-structured screening program is one of the most important recommendations of the past ten years in lung cancer," emphasizes DGP President Professor Wolfram Windisch, Chief Physician of the Pulmonary Clinic at the Kliniken der Stadt Köln. "However, organized prevention examinations must also include mandatory smoking cessation programs, as their additional benefit has been scientifically proven."
Still, a comprehensive lung cancer prevention and treatment program is urgently needed in Germany to improve survival rates. Contractual radiologists as well as radiology in a lung cancer-specialized center should ensure quality-assured examination and excellent reporting quality. "Each lung cancer center should be assigned a well-defined regional coverage area in Germany," says Professor Konstantin Nikolaou, President of the German Radiological Society (DRG) and Medical Director of the Department of Diagnostic and Interventional Radiology at the University Hospital Tübingen.
The position paper outlines in detail how an organized lung cancer early detection program can look in Germany. It not only defines the target group but also specifies the treatment methods, examination intervals, resource requirements, requirements for screening facilities, and the qualifications of the treating physicians. It is also stipulated that the examination and health assessment of affected patients can only be performed by an interdisciplinary team, including specialists in pulmonology, radiology, and thoracic surgery. "For comprehensive assessment and further treatment in lung cancer early detection, we need a broad expertise in case discussions. For thoracic surgery, a quality-assured early detection program using low-dose computed tomography is the key to recognizing lung cancer earlier than before and reducing mortality," says Dr. Katrin Welcker, Past President and Board Member of the German Society of Thoracic Surgery (DGT). She is a co-author of the presented position paper and Chief Physician at the Clinic for Thoracic Surgery, Kliniken Maria Hilf in Mönchengladbach.
While a lung cancer screening as a widespread organized preventive examination for risk groups does not yet exist, comparisons with the long-established mammography screening for breast cancer early detection in women point to enormous prospects for success, according to the experts. In addition to medical and health aspects, the position paper also considers economic points: "Lung cancer ranks first in both direct and indirect cancer-related healthcare costs in Europe," says author Torsten Blum. "According to our vision, health insurance companies should bear the costs of lung cancer screening. Several health economic models have meanwhile been able to demonstrate the cost-effectiveness of annual low-dose CT lung cancer screening programs," says the scientist.
https://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-2175-4580.pdf
