Lung cancer: CT screening works and can prevent over 36,000 deaths

Lung cancer screening could prevent 36,000 deaths. Thanks to early diagnosis, it would also lead to a 9.2-year improvement in the average survival of patients diagnosed by low-dose CT (LDCT) rather than by symptoms in Italy. According to the 20th Health Report produced by C.R.E.A. Sanità and the University of Rome Tor Vergata, screening for this type of cancer is not only clinically effective, but also cost-effective for the Italian healthcare system. In a 30-year horizon, the programme, once fully implemented, could avoid 36,061 deaths, reduce the total costs of treating the neoplasm by 1.8%, and total a gain of 0.9 million QALYs, a unit of health measurement that crosses years of life and the quality of life coefficient.

The scenario foreshadowed by the experts calls for specific programmes, ad hoc organisation and funding, dedicated diagnostic imaging sessions, patient recruitment, and a referral for treatment and possible surgery. Screening could be implemented and sustained thanks to the appropriations provided for in the 2026 manoeuvre, which, under the heading 'prevention', makes 238 million euros available annually, earmarked to strengthen breast, colorectal and lung cancer screening and to boost vaccinations. In Italy, apart from experimental programmes such as the R.I.S.P., the Italian Lung Screening Network, promoted by the National Institute of Tumours in Milan, and the pilot projects of some hospitals, lung cancer screening is not yet structured in the same way as it has been over time for breast, colorectal or cervical cancer, but, studies in hand, it could represent an effective weapon against an often silent killer. All the more so in view of the most recent epidemiological data estimating a 1.3% increase in incidence over the next few years in both sexes.

Lung cancer is the leading cause of oncological death in Italy, with more than 44,000 new cases and approximately 36,000 deaths each year related to the fact that the diagnosis often arrives at an advanced stage, as the disease can progress without any particular symptoms, when treatment options are limited and not very effective, and with a five-year survival rate that may be less than 10%. Cigarette smoking is the most significant risk factor for lung cancer, with 85-90% of all lung cancers attributable to it. The risk increases with the number of cigarettes smoked and the duration of the smoking habit. Currently, only one in four patients is operable at the time of diagnosis.

Radiological checks with low-impact CT scans on patients at risk could change this and other data in the future. The experience of the pilot project for the early diagnosis of lung cancer at the San Camillo Forlanini Hospital represents one of the concrete examples in this field. Almost a year after the programme was launched, the data collected on 1 November and released in the last few days show interesting results. Out of 700 low-dose computed tomography (CT) scans, 13 lung tumours have already been detected. Added to these are a pleural mesothelioma, a thymic gland tumour, two kidney tumours and a breast tumour, making a total of 18 tumours. In addition to the tumours, the CT scan detected 20 indeterminate nodules, small abnormalities that do not always indicate cancer but require further checks by the multidisciplinary board consisting of radiologists, pulmonologists, anatomic pathologists, thoracic surgeons, oncologists and radiation oncologists.

The initiative is aimed at the population group most at risk, i.e. heavy smokers over 55, who can apply through a questionnaire published on the company website. Out of 2,100 people who answered the questions formulated by the experts, 1,220 were deemed eligible and were included in the programme. The criteria for inclusion in the project include age over 55 and a history of at least 20 cigarettes a day for 20 years or 10 cigarettes a day for 40 years. Selected persons are offered a personalised smoking cessation pathway.