Aoife McNamara and Suzanne Wait

Lung cancer screening: the time is now

11 November 2021

Targeted screening can reduce the public health toll of lung cancer and improve quality of life. As November is Lung Cancer Awareness Month, we make the case for implementation of targeted screening programmes.

Lung cancer causes more deaths than any other cancer in Europe. It also costs more, and accounts for one quarter of productivity losses due to premature mortality from cancer. But in early 2020, the landmark NELSON trial published compelling findings that targeted screening using low-dose computed tomography could reduce mortality in lung cancer by up to a quarter.
 

The benefits of targeted lung cancer screening

Early detection through screening could transform lung cancer from a fatal disease (80% of people diagnosed with lung cancer die within one year) to a treatable one. Organised screening programmes are complex to implement and require an upfront investment in infrastructure and capacity – but several studies have suggested they are likely to be more cost-effective than other existing cancer screening programmes. They are also likely to be more efficient in terms of the number of people needed to screen to save one life from cancer.

The targeted nature of lung cancer screening means that only people at high risk of lung cancer are invited to attend. This maximises the benefits while reducing potential harms from screening, such as false positive findings and unnecessary exposure to radiation and exploratory procedures.

A recent report published by HPP and the Lung Ambition Alliance asserted that targeted lung screening should be regarded as the next big opportunity in cancer care. Yet experts in the field tell us that it is often difficult to convince policymakers to recognise this opportunity. COVID-19-related paralysis may be to blame – but only partly. Lung cancer has always been the poor relation among cancers. The Global Lung Cancer Coalition has performed numerous studies over the years which have shown that lung cancer receives less funding for research and less media coverage than other cancers.

The targeted nature of lung cancer screening means that only people at high risk of lung cancer are invited to attend. This maximises the benefits while reducing potential harms.

 

Tackling stigma head on

Many people have limited empathy for people with lung cancer, often viewing it as a self-inflicted condition. Research by the Global Lung Cancer Coalition in 2017 found that a staggering 21% of people worldwide admitted that they have less sympathy for people with lung cancer than those with other forms of cancer, and these figures were replicated at a national level for most member organisations. The stigma and association with smoking is important to recognise and address, as it has real impact on people diagnosed with lung cancer.
 

Distress and impact on quality of life

Feelings of stigmatisation only add to the significant impact that lung cancer already has on people’s lives. People with lung cancer often suffer more distress than those diagnosed with other cancers. A landmark study in 2011 examined the prevalence of psychological distress caused by cancer and found that, of the patients surveyed, 43% of people with lung cancer experienced elevated levels of distress in comparison with 32% of people with breast cancer, 31% of people with bowel cancer and 30% of people with prostate cancer. And a 2010 study showed that nearly 40% of lung cancer patients reported levels of distress and depressive symptoms that would be considered clinically significant.

A staggering 21% of people worldwide admitted that they have less sympathy for people with lung cancer than those with other forms of cancer.

 
The high level of distress seen in people with lung cancer can be attributed to a number of factors, including:

  • being diagnosed with a high-mortality cancer
  • being diagnosed at an advanced stage with a poor prognosis
  • post-treatment side effects
  • comorbidities or debilitating symptoms
  • nihilistic attitude among the public, media and healthcare professionals
  • stigma, shame and blame
  • being less likely to access supportive services.

 

Shifting attitudes is the necessary starting point for reducing the burden of lung cancer

Reduced mortality from lung cancer can dramatically decrease the economic toll of cancer. The evidence supporting targeted lung cancer screening supports its implementation. The time to act is now.

An important starting point is to consider smoking as an addiction worthy of support and treatment. Investment in early detection of lung cancer will not just reduce the economic toll of cancer on our society, but can transform lung cancer into a treatable condition, with significant impact on people’s quality of life. Both from a public health and a human perspective, lung cancer screening is worth the investment. For a person with lung cancer, time is everything – and the time for screening is now.
 
This blog was written by Aoife McNamara, Information Development Manager at the Irish Cancer Society and Steering Committee Member for the Global Lung Cancer Coalition, and Suzanne Wait, Managing Director at The Health Policy Partnership. 

 

The opinions expressed in this blog are those of the authors and do not necessarily represent the views of The Health Policy Partnership.
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