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Review
. 2021 Feb;10(2):1050-1063.
doi: 10.21037/tlcr-20-985.

Implementation of lung cancer screening: what are the main issues?

Carlijn M van der Aalst  1 , Kevin Ten Haaf  1 , Harry J de Koning  1
Affiliations
Review

Implementation of lung cancer screening: what are the main issues?

Carlijn M van der Aalst et al. Transl Lung Cancer Res. 2021 Feb.

Abstract

Two large-scale RCTs have shown computed tomography (CT) lung cancer screening to be efficacious in reducing lung cancer mortality (8-24% in men, 26-59% in women). However, lung cancer screening implicitly means personalised and risk-based approaches. Health care systems' implementation of personalised screening and prevention is still sparse, and likely to be of variable quality, because of important remaining uncertainties, which have been incompletely addressed or not at all so far. Further optimisation of lung cancer screening programs is expected to reduce harms and maintain or enhance benefit for eligible European citizens, whilst significantly reducing health care costs. Some main uncertainties (e.g., Risk-based eligibility, Risk-based screening intervals, Volume CT screening, Smoking Cessation, Gender and Sex differences, Cost-Effectiveness) are discussed in this review. 4-IN-THE-LUNG-RUN (acronym for: Towards INdividually tailored INvitations, screening INtervals and INtegrated co-morbidity reducing strategies in lung cancer screening) is the first multi-centred implementation trial on volume CT lung cancer screening amongst 24,000 males and females, at high risk for developing lung cancer, across five European countries, started in January 2020. Through providing answers to the remaining questions with this trial, many EU citizens will swiftly benefit from this high-quality screening technology, others will face less harms than previously anticipated, and health care costs will be substantially reduced. Implementing a new cancer screening programme is a major task, with many stakeholders and many possible facilitators but also barriers and obstacle.

Keywords: Lung cancer; computed tomography scanning (CT scanning); early detection; implementation; screening.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-985). The series “Implementation of CT-based screening of lung cancer” was commissioned by the editorial office without any funding or sponsorship. CM van der Aalst reports grants from European Commission - Horizon 2020, during the conduct of the study; grants and non-financial support from Central European Lung Cancer Conference, grants from NIH/National Cancer Institute, outside the submitted work. KTH reports grants from European Union (Horizon 2020), during the conduct of the study; grants from University of Zurich, Switzerland, non-financial support from International Association for the Study of Lung Cancer, non-financial support from International Association for the Study of Lung Cancer, grants from Cancer Research UK, non-financial support from Russian Society of Clinical Oncology, non-financial support and other from Biomedical Research in Endstage And Obstructive Lung Disease Hannover (BREATH), grants from NIH/National Cancer Institute, outside the submitted work. HJ de Koning reports grants from European Commission – Horizon 2020, during the conduct of the study; personal fees from speakers fee, other from NHS England, grants from NIH/National Cancer Institute, outside the submitted work. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Examples of tasks of organization, evaluation, and governance in different phases of implementation and quality improvement of a cancer screening programme [re-used with permission of ref. (14)].
Figure 2
Figure 2
Challenges in the implementation of lung cancer screening.
Figure 3
Figure 3
Potential barriers in the implementation of lung cancer screening.
See this image and copyright information in PMC

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