Project description
Evaluating strategies in lung cancer screening
Lung cancer (LC) is the main cause of cancer deaths in the EU, claiming 338 000 lives each year. The crucial next method to prevent a great number of these deaths is low-dose CT (Computer Tomography) screening for lung cancer. However, its implementation meets several obstacles resulting in limited and slow use while the need is at perhaps 25 million CT screens annually in Europe, and there are many uncertainties related to the most optimal and cost-effective strategy to apply. Personalised treatment based on the baseline CT result can reduce LC mortality and harm associated with screening; it can also significantly reduce costs. The EU-funded 4-IN THE LUNG RUN project consists of a randomised controlled trial engaging 24 000 individuals aiming to evaluate when it is safe to increase risk-based screening intervals after a negative baseline CT. It is a multi-center implementation trial in 5 countries, with an additional focus on individual optimal recruitment and smoking cessation strategies, co-morbidity reducing strategies (like the use of a calcium score for CVD), and biomarkers.
Objective
With 338,000 EU-deaths annually, lung cancer is a devastating problem. CT screening has the potential to prevent ten-thousands of lung cancer deaths annually. The positive results of the Dutch-Belgian screening trial (NELSON), with relatively low referral rates, and the NLST in the USA provided conclusive evidence. However, implementation is likely to be limited, slow and of variable quality throughout Europe, and current guidelines could easily require up to 25 million CT screens annually. The most optimal strategy in risk-based lung-thoracic screening is still unknown regarding the optimal and most cost-effective (e.g. targeted) strategy 1) to recruit, 2) to integrate smoking cessation and co-morbidity-reducing services, and 3) to determine the (risk-based) screening interval. Personalised regimens based on the baseline CT result can potentially retain 85% of the mortality reduction achievable through screening at 45% less screens, thus potentially saving much unnecessary harm associated with screening, and 0.5-1 billion Euros per year. The heart of 4-IN-THE-LUNG-RUN is a randomised controlled trial amongst 24,000 individuals evaluating whether it is safe to have risk-based less intensive screening intervals after a negative baseline CT. Various methods to improve participation of hard-to-reach individuals will be assessed in five different healthcare settings. Innovative co-morbidity reducing strategies will be tested including other markers on CT imaging, as Calcium Score and COPD. Cost impact and cost-effectiveness analyses using a natural history model will steer implementation. The experienced consortium will strongly interact with key stakeholders, and discuss interim results with key other international initiatives on CT screening, biomarkers, and smoking cessation practices. This proposal will form the evidence base for risk-based lung cancer screening with huge benefits for the EU, on health outcomes, cost savings, and innovation in the long run.
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Funding Scheme
RIA - Research and Innovation actionCoordinator
3015 GD Rotterdam
Netherlands