Lung cancer, screening can save lives: who needs it, how it is done and why it is important

Arriving early in medicine is crucial. Thanks to early diagnosis, it is possible to identify cancer in its early stages, with obvious positive repercussions on both the intensity of treatment and future prospects for cure. If for breast, colorectal and cervical cancer the screening pathway is broadly defined in terms of age groups and testing strategies to be performed, data are now clearly emerging indicating the value of this approach in individuals at high risk of developing lung cancer. It is performed with low-dose spiral CT scans, annually. It should be included in secondary prevention protocols for heavy smokers and thus be included in the new Essential Levels of Care (LEA). The experts of the Italian Association of Medical Oncology (AIOM) are calling for this, following the recent decision of the State-Regions Conference to approve the update of the LEAs.

According to the specialists, screening should be added to the three secondary prevention programmes already included in the services guaranteed by the National Health Service: for breast, colorectal and cervical cancer. "It is a measure that we have been waiting for since 2017 and that can also improve and enhance the health care of the more than 3.7 million cancer patients living in Italy," recalled Massimo Di Maio, AIOM President at the press conference of the XXVII National Congress of the Scientific Society that has just closed in Rome. "However, it must be integrated, providing for the screening programme for lung cancer. In the 2026 budget bill, resources are foreseen to increase the number of participants in the Italian Lung Screening Network, the RISP Programme'. The project, through low-dose Computed Tomography (CT), aims to promote the early diagnosis of lung cancer. It is indicated for people considered to be at risk: age 55-75, heavy smokers (average consumption of 15 cigarettes a day for more than 25 years or at least 10 cigarettes a day for more than 30 years) or ex-heavy smokers (habit stopped less than a decade ago).

What is certain is that, on the basis of the evidence, the implementation of this screening pathway could really change the trajectory of recognition and treatment of a disease where the time of diagnosis is a key aspect of the course. Thanks to the monitoring CT scan, this can be positively influenced. Compared to the standard chest X-ray, the examination reduces lung cancer mortality by 20%. 'It has been shown that it can prevent more than 36,000 deaths over 30 years,' Di Maio points out. In addition, it can reduce indirect healthcare costs related to the disease by 5.9 per cent and the cost of purchasing anti-cancer drugs by 5.9 per cent'. Currently, it must be said, the annual examination is not yet approved or reimbursed by the National Health Service. We therefore welcome the implementation of the RISP programme, but we suggest that the institutions provide for periodic examinations for people considered at risk in all 21 local health systems in the Peninsula. "In this way, we can contain the impact of lung neoplasms, which every year in Italy register more than 44 thousand new diagnoses and more than 35 thousand deaths," comments Massimiliano Cani, a specialist in Medical Oncology and PhD student in Translational Oncology at the AOU San Luigi Gonzaga di Orbassano-University of Turin. Screening for lung cancer is effective, economically viable and can benefit the entire system'.

In the area of breast cancer, 53,000 diagnosed every year in Italy, the two-yearly mammography test has saved 13,660 lives in five years thanks to the early diagnosis provided by screening. But of course the mammography test is only one step on the path to advancing treatment, in the field of precision oncology. According to Alessandra Fabi, AIOM National Councillor, 'one of the important steps forward in the last 20 years is represented by genomic tests that allow real personalisation of treatments and avoid the administration of useless therapies. They are fundamental tests, in fact, they have been included in the update of the LEAs'. They are used in breast carcinoma that responds to hormones to establish, after surgery, whether or not it is necessary to resort only to hormone therapy and thus avoid the addition of other more invasive treatments to prevent disease recurrence. They obviously make it possible to be even more precise and appropriate in treatment. 'One of the tests available in Italy has been shown to reduce the use of chemotherapy by 48%,' Fabi reports. At the national level, a fund of 20 million euro was created in 2020 to purchase genomic tests for 10,000 patients a year. Now these resources have almost run out and, according to the latest scientific studies, the number of women in our country who need the test amounts to 13 thousand a year. The fund must therefore be increased by a further five million to ensure examinations that must be permanently included in clinical practice'.