– Early detection reduces the risk of death by 20 percent
A group of experts recommends systematic early detection programs for heavy smokers. Why is it still taking time for those affected to benefit?
According to federal data, more than a quarter of smokers will eventually die from lung cancer — the second leading cause of tobacco-related death after cardiovascular disease. Many of these deaths could be prevented in the future. That is the conclusion that is reached national cancer screening expert panel, which released a recommendation Tuesday to offer low-dose computed tomography (CT) screening to people at risk for lung cancer. In Switzerland, systematic early detection of the most common cause of cancer death is much closer.
“The benefit is comparable to the established early detection of colorectal cancer and mammography,” says Marcel Zwahlen, president of the expert panel. “Therefore, there is no reason not to support systematic screening for lung cancer.” If heavy smokers or ex-smokers get screened every one to two years for ten years, they can reduce their risk of dying from lung cancer by up to 20 percent. According to the available studies, with annual screening, for 10,000 heavy smokers, the number of deaths could decrease from 200 to about 160 over 10 years.
No false security for smokers
Doctors have long hoped for early detection of lung tumors. Today, cancer is still mostly very advanced and therefore difficult to treat once it appears. In Switzerland, the Federal Office of Public Health (BAG) rejected an application for lung cancer screening in 2016. The study situation was too rare, it was said at the time. Since then, in 2020, new promising data from a large study from the Netherlands has been published, which has now led to a positive recommendation for the attention of the FOPH and the cantons.
The expert panel did not specify exact criteria for an early detection program. Those would have to be worked out later, Zwahlen says. However, experts suggest that screening should only be offered to healthy people over the age of 55 and with approximately 20 years of so-called “packing”. For example, they smoked 20 cigarettes (a pack) a day for 20 years or 40 cigarettes a day for 10 years. In Switzerland, an estimated 100,000 to 320,000 people would currently meet these criteria.
“People at risk should be encouraged to stop smoking without paternalism, regardless of whether or not they have a screening test.”
Marcel Zwahlen, President of the National Expert Committee on Early Cancer Detection
The fear that the possibility of early detection or an inconspicuous finding could tempt smokers to smoke longer or more often does not seem to be correct. Then the corresponding program would lead not to less, but to more cancer, heart attacks and strokes.
Bernese epidemiologist Marcel Zwahlen rejects this: “In sometimes very large studies, there was no evidence of such a paradoxical effect.” He even sees the possibility of the opposite effect. “As part of the screening, heavy smokers are confronted with the risk of lung cancer, which they may prefer to suppress.” This could also motivate them to quit smoking. “People at risk should be supported without paternalism, regardless of whether or not they have early detection screening,” says Zwahlen.
However, the exact benefit of screening depends on how the program is specifically set up. From the expert panel’s point of view, it is absolutely necessary to prevent so-called wild screening. Providers operate early detection outside of systematic programs and The criteria for participation and the procedure after a striking finding are not so precise. A CT scan then risks doing more harm than good. For example, when younger people and smokers rarely go for screening, there are more false alarms, more follow-up examinations, more complications and interventions that would never have taken place without screening.
Without screening programs, there is a risk of unequal treatment
Without screening programs paid for by health insurance companies, there is also the risk of unequal treatment, because those who are worse off do not have the money for early detection – a situation that the panel of experts and the Cancer League would like to address. avoid. However, there have been providers in Switzerland for years who have been performing such CT scans with relaxed criteria and relatively cheaply. Business model, because additional examinations due to frequent and unclear findings are then charged to the basic insurance.
The positive evaluation that has now been published is an important step on the winding road to systematic early detection of lung cancer in Switzerland. It is true that the BAG, together with the Health Directors’ Conference (GDK), sponsors the expert panel on early cancer detection and commissioned the assessment itself. However, the BAG does nothing until interested parties apply for funding for screening programs. The relevant commission at the BAG would then have to carry out another assessment, which, in the case of a positive decision, would have to be assessed by the Federal Council. Then it would be the turn of the cantonal health authorities. Because in order for the basic insurance to cover the costs of early detection, all cantons have to set up their own screening program.
Felix Straumann is the Deputy Leader of the Science/Medicine Team and a Science Journalist. He has a master’s degree in microbiology and spent many years in university hospital laboratories and in the private sector before becoming a journalist.More information@fstraum
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