Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 152 No. 1516 (2022)

The Swiss Approach – feasibility of a national low-dose CT lung cancer screening program

  • Lisa Jungblut
  • Christophe von Garnier
  • Milo Puhan
  • Yuki Tomonaga
  • Cornel Kaufmann
  • Andrea Azzola
  • Urs Bürgi
  • Jens Bremerich
  • Martin Brutsche
  • Andreas Christe
  • Lukas Ebner
  • Johannes T Heverhagen
  • Christine Eich
  • Daniel Franzen
  • Isabelle Schmitt-Opitz
  • Didier Schneiter
  • Jörg Spieldenner
  • Nigel Horwarth
  • Malcolm Kohler
  • Walter Weder
  • Alban Lovis
  • Reto Meuli
  • Matthias Menig
  • Catherine Beigelmann-Aubry
  • Tilo Niemann
  • Susanna Stöhr
  • Peter Vock
  • Oliver Senn
  • Stefan Neuner-Jehle
  • Kevin Selby
  • Simin Laures
  • Sebastian Ott
  • Thomas Frauenfelder
DOI
https://doi.org/10.4414/SMW.2022.w30154
Cite this as:
Swiss Med Wkly. 2022;152:w30154
Published
14.04.2022

Summary

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths in Switzerland. Despite this, there is no lung cancer screening program in the country. In the United States, low-dose computed tomography (LDCT) lung cancer screening is partially established and endorsed by guidelines. Moreover, evidence is growing that screening reduces lung cancer-related mortality and this was recently shown in a large European randomized controlled trial. Implementation of a lung cancer screening program, however, is challenging and depends on many country-specific factors. The goal of this article is to outline a potential Swiss lung cancer screening program.

FRAMEWORK: An exhaustive literature review on international screening models as well as interviews and site visits with international experts were initiated. Furthermore, workshops and interviews with national experts and stakeholders were conducted to share experiences and to establish the basis for a national Swiss lung cancer screening program.

SCREENING APPROACH: General practitioners, pulmonologists and the media should be part of the recruitment process. Decentralisation of the screening might lead to a higher adherence rate. To reduce stigmatisation, the screening should be integrated in a “lung health check”. Standardisation and a common quality level are mandatory. The PLCOm2012 risk calculation model with a threshold of 1.5% risk for developing cancer in the next six years should be used in addition to established inclusion criteria. Biennial screening is preferred. LUNG RADS and NELSON+ are applied as classification models for lung nodules.

CONCLUSION: Based on data from recent studies, literature research, a health technology assessment, the information gained from this project and a pilot study the Swiss Interest Group for lung cancer screening (CH-LSIG) recommends the timely introduction of a systematic lung cancer screening program in Switzerland. The final decision is for the Swiss Cancer Screening Committee to make. 

References

  1. Ferlay J, Colombet M, Soerjomataram I, Dyba T, Randi G, Bettio M, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018 Nov;103:356–87. https://doi.org/10.1016/j.ejca.2018.07.005
  2. Malvezzi M, Carioli G, Bertuccio P, Boffetta P, Levi F, La Vecchia C, et al. European cancer mortality predictions for the year 2017, with focus on lung cancer. Ann Oncol. 2017 May;28(5):1117–23. https://doi.org/10.1093/annonc/mdx033
  3. Varecza Z, Elekes K, László T, Perkecz A, Pintér E, Sándor Z, et al. Expression of the somatostatin receptor subtype 4 in intact and inflamed pulmonary tissues. J Histochem Cytochem. 2009 Dec;57(12):1127–37. https://doi.org/10.1369/jhc.2009.953919
  4. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, et al.; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug;365(5):395–409. https://doi.org/10.1056/NEJMoa1102873
  5. de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020 Feb;382(6):503–13. https://doi.org/10.1056/NEJMoa1911793
  6. ECHAlliance. 2020. Accessed at https://echalliance.com/croatia-first-to-introduce-early-screening-for-lung-cancer/Accessed January 20, 2020.
  7. Breathing in a new era. A comparative analysis of lung cancer policies across Europe. The Economist, Intelligence Unit. 2020.
  8. Rzyman W, Szurowska E, Adamek M. Implementation of lung cancer screening at the national level: polish example. Transl Lung Cancer Res. 2019 May;8(S1 Suppl 1):S95–105. https://doi.org/10.21037/tlcr.2019.03.09
  9. Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, et al. Implementing lung cancer screening: baseline results from a community-based ‘Lung Health Check’ pilot in deprived areas of Manchester. Thorax. 2019 Apr;74(4):405–9. https://doi.org/10.1136/thoraxjnl-2017-211377
  10. Field JK, deKoning H, Oudkerk M, Anwar S, Mulshine J, Pastorino U, et al. Implementation of lung cancer screening in Europe: challenges and potential solutions: summary of a multidisciplinary roundtable discussion. ESMO Open. 2019 Oct;4(5):e000577. https://doi.org/10.1136/esmoopen-2019-000577
  11. Yang D, Liu Y, Bai C, Wang X, Powell CA. Epidemiology of lung cancer and lung cancer screening programs in China and the United States. Cancer Lett. 2020 Jan;468:82–7. https://doi.org/10.1016/j.canlet.2019.10.009
  12. Thomson CC, Mckee AB. American Thoracic Society/American Lung Association Lung Cancer Screening Implementation Guide. Am J Respir Crit Care Med. 2018 Nov;198(9):1120–1. https://doi.org/10.1164/rccm.201809-1699ED
  13. Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, et al.; US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar;325(10):962–70. https://doi.org/10.1001/jama.2021.1117
  14. Arndt V. ea. Schweizerischer Krebsbericht 2015. Stand und Entwicklungen. Bundesamt für Statistik (BFS), Nationales Institut für Krebsepidemiologie und –registrierung (NICER), Schweizer Kinderkrebsregister (SKKR); 2016.
  15. https://cancerscreeningcommittee.ch/. Cancer Screening Comitee. 2014.
  16. Oudkerk M, Liu S, Heuvelmans MA, Walter JE, Field JK. Lung cancer LDCT screening and mortality reduction - evidence, pitfalls and future perspectives. Nat Rev Clin Oncol. 2021 Mar;18(3):135–51. https://doi.org/10.1038/s41571-020-00432-6
  17. Bradley SH, Shinkins B, Kennedy MP. What is the balance of benefits and harms for lung cancer screening with low-dose computed tomography? J R Soc Med. 2021 Apr;114(4):164–70. https://doi.org/10.1177/0141076821991108
  18. Bucher HC SD, Tomonaga Y. Low-dose CT screening for lung cancer. 2021.
  19. Dawson Q. NELSON trial: reduced lung-cancer mortality with volume CT screening. Lancet Respir Med. 2020 Mar;8(3):236. https://doi.org/10.1016/S2213-2600(20)30059-X
  20. Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, et al. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel). 2020 Jun;12(6):E1672. https://doi.org/10.3390/cancers12061672
  21. Sadate A, Occean BV, Beregi JP, Hamard A, Addala T, de Forges H, et al. Systematic review and meta-analysis on the impact of lung cancer screening by low-dose computed tomography. Eur J Cancer. 2020 Jul;134:107–14. https://doi.org/10.1016/j.ejca.2020.04.035
  22. Lowenstein LM, Godoy MC, Erasmus JJ, Zirari Z, Bennett A, Leal VB, et al. Implementing Decision Coaching for Lung Cancer Screening in the Low-Dose Computed Tomography Setting. JCO Oncol Pract. 2020 Aug;16(8):e703–25. https://doi.org/10.1200/JOP.19.00453
  23. Martínez Pérez E, de Aguiar Quevedo K, Arrarás Martínez M, Cruz Mojarrieta J, Arana Fernández de Moya E, Barrios Benito M, et al. Lung Cancer Screening: Use of Low-Dose Computed Tomography [Engl Ed]. Arch Bronconeumol. 2019 Oct;55(10):526–31. https://doi.org/10.1016/j.arbr.2019.08.001
  24. Wattson DA, Hunink MG, DiPiro PJ, Das P, Hodgson DC, Mauch PM, et al. Low-dose chest computed tomography for lung cancer screening among Hodgkin lymphoma survivors: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys. 2014 Oct;90(2):344–53. https://doi.org/10.1016/j.ijrobp.2014.06.013
  25. Wade S, Weber M, Caruana M, Kang YJ, Marshall H, Manser R, et al. Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia. J Thorac Oncol. 2018 Aug;13(8):1094–105. https://doi.org/10.1016/j.jtho.2018.04.006
  26. Tomonaga Y, Ten Haaf K, Frauenfelder T, Kohler M, Kouyos RD, Shilaih M, et al. Cost-effectiveness of low-dose CT screening for lung cancer in a European country with high prevalence of smoking-A modelling study. Lung Cancer. 2018 Jul;121:61–9. https://doi.org/10.1016/j.lungcan.2018.05.008
  27. Shmueli A, Fraifeld S, Peretz T, Gutfeld O, Gips M, Sosna J, et al. Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: the Israeli experience. Value Health. 2013 Sep-Oct;16(6):922–31. https://doi.org/10.1016/j.jval.2013.05.007
  28. Raymakers AJ, Mayo J, Lam S, FitzGerald JM, Whitehurst DG, Lynd LD. Cost-Effectiveness Analyses of Lung Cancer Screening Strategies Using Low-Dose Computed Tomography: a Systematic Review. Appl Health Econ Health Policy. 2016 Aug;14(4):409–18. https://doi.org/10.1007/s40258-016-0226-5
  29. Puggina A, Broumas A, Ricciardi W, Boccia S. Cost-effectiveness of screening for lung cancer with low-dose computed tomography: a systematic literature review. Eur J Public Health. 2016 Feb;26(1):168–75. https://doi.org/10.1093/eurpub/ckv158
  30. Lopci E, Castello A, Morenghi E, Tanzi D, Cavuto S, Lutman F, et al. Cost-effectiveness of second-line diagnostic investigations in patients included in the DANTE trial: a randomized controlled trial of lung cancer screening with low-dose computed tomography. Nucl Med Commun. 2019 May;40(5):508–16. https://doi.org/10.1097/MNM.0000000000000993
  31. Jaine R, Kvizhinadze G, Nair N, Blakely T. Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer. 2020 Jun;144:99–106. https://doi.org/10.1016/j.lungcan.2020.03.010
  32. Jaine R, Kvizhinadze G, Nair N, Blakely T. Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer. 2018 Oct;124:233–40. https://doi.org/10.1016/j.lungcan.2018.08.004
  33. Griffin E, Hyde C, Long L, Varley-Campbell J, Coelho H, Robinson S, et al. Lung cancer screening by low-dose computed tomography: a cost-effectiveness analysis of alternative programmes in the UK using a newly developed natural history-based economic model. Diagn Progn Res. 2020 Dec;4(1):20. https://doi.org/10.1186/s41512-020-00087-y
  34. Field JK, Duffy SW, Baldwin DR, Brain KE, Devaraj A, Eisen T, et al. The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer. Health Technol Assess. 2016 May;20(40):1–146. https://doi.org/10.3310/hta20400
  35. Esmaeili MH, Seyednejad F, Mahboub-Ahari A, Ameri H, Abdollahzad H, Safaei N, et al. Cost-effectiveness analysis of lung cancer screening with low-dose computed tomography in an Iranian high-risk population. J Med Screen. 2021 Dec;28(4):494–501. https://doi.org/10.1177/09691413211018253
  36. Du Y, Sidorenkov G, Heuvelmans MA, Groen HJ, Vermeulen KM, Greuter MJ, et al. Cost-effectiveness of lung cancer screening with low-dose computed tomography in heavy smokers: a microsimulation modelling study. Eur J Cancer. 2020 Aug;135:121–9. https://doi.org/10.1016/j.ejca.2020.05.004
  37. Crengle S. Comment on: Jaine et al Cost-effectiveness of a low-dose computed tomography screening programme for lung cancer in New Zealand. Lung Cancer 2018, 124, 233-240. 2018/10/01. DOI: https://doi.org/10.1016/j.lungcan.2018.08.004. Lung Cancer. 2020;145:219-20.
  38. Wiener RS, Gould MK, Arenberg DA, Au DH, Fennig K, Lamb CR, et al.; ATS/ACCP Committee on Low-Dose CT Lung Cancer Screening in Clinical Practice. An official American Thoracic Society/American College of Chest Physicians policy statement: implementation of low-dose computed tomography lung cancer screening programs in clinical practice. Am J Respir Crit Care Med. 2015 Oct;192(7):881–91. https://doi.org/10.1164/rccm.201508-1671ST
  39. Printz C. US Preventive Services Task Force issues new draft recommendation statement regarding lung cancer screening. Cancer. 2020 Oct;126(19):4269. https://doi.org/10.1002/cncr.33193
  40. Moyer VA, Force US ; U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014 Mar;160(5):330–8. https://doi.org/10.7326/M13-2771
  41. Force US ; U.S. Preventive Services Task Force. Lung cancer screening: recommendation statement. Ann Intern Med. 2004 May;140(9):738–9. https://doi.org/10.7326/0003-4819-140-9-200405040-00014
  42. Zhou QH, Fan YG, Bu H, Wang Y, Wu N, Huang YC, et al. China national lung cancer screening guideline with low-dose computed tomography (2015 version). Thorac Cancer. 2015 Nov;6(6):812–8. https://doi.org/10.1111/1759-7714.12287
  43. Smetana GW, Boiselle PM, Schwartzstein RM. Screening for Lung Cancer With Low-Dose Computed Tomography: Grand Rounds Discussion From the Beth Israel Deaconess Medical Center. Ann Intern Med. 2015 Apr;162(8):577–82. https://doi.org/10.7326/M15-0055
  44. Lee C. Screening for Lung Cancer: Effective Recruitment Methods. AJR Am J Roentgenol. 2018 Mar;210(3):514–7. https://doi.org/10.2214/AJR.17.18755
  45. Strong A, Renaud M. Using Social Media as a Platform for Increasing Knowledge of Lung Cancer Screening in High-Risk Patients. J Adv Pract Oncol. 2020 Jul;11(5):453–9.
  46. Hinshaw LB, Jackson SA, Chen MY. Direct mailing was a successful recruitment strategy for a lung-cancer screening trial. J Clin Epidemiol. 2007 Aug;60(8):853–7. https://doi.org/10.1016/j.jclinepi.2006.11.005
  47. Gren L, Broski K, Childs J, Cordes J, Engelhard D, Gahagan B, et al. Recruitment methods employed in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Clin Trials. 2009 Feb;6(1):52–9. https://doi.org/10.1177/1740774508100974
  48. Balata H, Tonge J, Barber PV, Colligan D, Elton P, Evison M, et al. Attendees of Manchester’s Lung Health Check pilot express a preference for community-based lung cancer screening. Thorax. 2019 Dec;74(12):1176–8. https://doi.org/10.1136/thoraxjnl-2018-212601
  49. Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, et al. Second round results from the Manchester ‘Lung Health Check’ community-based targeted lung cancer screening pilot. Thorax. 2019 Jul;74(7):700–4. https://doi.org/10.1136/thoraxjnl-2018-212547
  50. Prorok PC, Andriole GL, Bresalier RS, Buys SS, Chia D, Crawford ED, et al.; Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Project Team. Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Control Clin Trials. 2000 Dec;21(6 Suppl):273S–309S. https://doi.org/10.1016/S0197-2456(00)00098-2
  51. Selby K, Gubelmann R, Lovis A, Bulliard JL, Beigelman-Aubry C, Casutt A, et al. [Lung cancer screening: what can we tell our patients while we await a screening program? ]. Rev Med Suisse. 2020 Nov;16(713):2086–91. https://doi.org/10.53738/REVMED.2020.16.713.2086
  52. Sverzellati N, Silva M, Calareso G, Galeone C, Marchianò A, Sestini S, et al. Low-dose computed tomography for lung cancer screening: comparison of performance between annual and biennial screen. Eur Radiol. 2016 Nov;26(11):3821–9. https://doi.org/10.1007/s00330-016-4228-3
  53. ESTI. https://www.myesti.org/content-esti/uploads/ESTI-LCS-technical-standards_2019-06-14.pdf. 2019.
  54. Radiology ACo. 2019. Lung‐RADS® Version 1.1. Accessed at https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADSAssessmentCategoriesv1-1.pdf Accessed January 1, 2020.
  55. Xu DM, Gietema H, de Koning H, Vernhout R, Nackaerts K, Prokop M, et al. Nodule management protocol of the NELSON randomised lung cancer screening trial. Lung Cancer. 2006 Nov;54(2):177–84. https://doi.org/10.1016/j.lungcan.2006.08.006
  56. Silva M, Milanese G, Sestini S, Sabia F, Jacobs C, van Ginneken B, et al. Lung cancer screening by nodule volume in Lung-RADS v1.1: negative baseline CT yields potential for increased screening interval. Eur Radiol. 2021 Apr;31(4):1956–68. https://doi.org/10.1007/s00330-020-07275-w
  57. McKee BJ, McKee AB, Kitts AB, Regis SM, Wald C. Low-dose computed tomography screening for lung cancer in a clinical setting: essential elements of a screening program. J Thorac Imaging. 2015 Mar;30(2):115–29. https://doi.org/10.1097/RTI.0000000000000139
  58. Becker N, Motsch E, Gross ML, Eigentopf A, Heussel CP, Dienemann H, et al. Randomized Study on Early Detection of Lung Cancer with MSCT in Germany: Results of the First 3 Years of Follow-up After Randomization. J Thorac Oncol. 2015 Jun;10(6):890–6. https://doi.org/10.1097/JTO.0000000000000530
  59. Patz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, et al.; NLST Overdiagnosis Manuscript Writing Team. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014 Feb;174(2):269–74. https://doi.org/10.1001/jamainternmed.2013.12738
  60. Marshall HM, Bowman RV, Yang IA, Fong KM, Berg CD. Screening for lung cancer with low-dose computed tomography: a review of current status. J Thorac Dis. 2013 Oct;5 Suppl 5:S524–39.

Most read articles by the same author(s)

<< < 1 2 3 4 5 6 > >>