#EAPM: plaučių ir kitų vėžio profilaktika ES

On Saturday (14 October), Yokohama in Japan will host a symposium on the Advances in Lung Cancer CT Screening, rašo Europos aljansas už Pritaikomo Medicina (EAPM) vykdomasis direktorius Denisas Horgan. 

The event seeks to provide a forum for in-depth reviews of core issues regarding the current status of lung cancer screening. It will feature internationally recognized experts in an interactive setting.

A key focus will also be a review of how related research areas, such as medical and surgical interventions, are intersecting with screening research. The evolution of biomarker research will also be highlighted.

The Brussels-based European Alliance for Personalised Medicine will be present at the meeting, represented by Executive Director Denis Horgan.

Figures show that lung cancer causes almost 1.4 million deaths each year worldwide, representing almost one-fifth of all cancer deaths. Within the EU, lung cancer is also the biggest killer of all cancers, responsible for almost 270,000 annual deaths (some 21%).

Yet the biggest cancer killer of all does not have a solid set of screening guidelines across Europe, despite the need for doctors to improve decision making for the benefit of their patients.

Many stakeholders believe there is a need for more guidelines across the arena of healthcare, especially in screening for lung cancer. There is also a need for agreement and coordination across the European Union’s current 28 Member States on various screening programmes covering other disease areas.

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Put bluntly, swift and effective action is needed from within the EU.

And it’s not just lung cancer, of course. According to the European Guide on Quality Improvement in Comprehensive Cancer Control, published in February 2017 and put forward by the Maltese EU presidency: “In 2012 alone, 2.6 million European Union citizens were newly diagnosed with some form of cancer and the estimated total number of cancer deaths in the European Union (that year) was 1.26 million.”

The report continued: “Given today's incidence rates, we expect that one-in-three men and one-in-four women in the European Union will be directly affected by cancer before reaching 75 years of age.”

Cancer costs the EU billions annually, mainly in terms of health-care expenditure and lost productivity due to early death and sick days.

But screening for diseases - such as breast and prostate cancers, as well as lung - has always been a topic beset with arguments, as well as debates about the pros and cons.

Many argue, for example, that over-testing can lead to over-treatment, including unnecessary invasive surgery. The over-treatment argument has often been used in respect of breast cancer screening, although the figures tend to show that it works very well in a preventative sense and even better in detecting early breast cancer in target age groups.

PSA testing for prostate cancer has also come in for similar criticism.

The counter-arguments - and they are very strong ones - is that our ‘social contract’ has obligations to ensure to the highest standards possible regarding the health of citizens and that, fiscally, forewarned is forearmed and can save a great deal of money down the line.

The majority of experts (and, importantly, patients) would argue that there is a clear added value in properly run screening programmes, although this may vary - as do resources - across member states (and within regions).

These differences also affect data collection, storage and sharing, the general delivery of healthcare, and levels of reimbursement, to name but a few.

And, without doubt, all screening programmes have to be based on gathered evidence of efficacy, cost effectiveness and risk. Any new screening initiative should also factor in education, testing and programme management, as well as other aspects such as quality-assurance measures.

Du gyvybiškai bottom-linijos, kad prieiga prie tokių atrankinės patikros programas, turi būti teisingas, be tikslinių gyventojų, ir kad išmoka gali būti aiškiai parodyta, kad nusvertų bet kokią žalą.

As long ago as December 2003 the EU produced a Recommendation on cancer screening, stating that efforts should be taken to encourage citizens to take part in (and have access) to cancer screening programmes.

Tuo metu Komisija jau buvo paskelbusi atnaujintas ir išplėstas ES krūties ir gimdos kaklelio vėžio patikros gaires, tuo tarpu buvo rengiamos išsamios Europos gaubtinės ir tiesiosios žarnos vėžio patikros kokybės užtikrinimo gairės.

Fourteen years on and incidence and mortality rates of cancers still vary widely across the EU, often splitting large and smaller countries along with richer and poorer nations. Therefore, as stated, there needs to be concrete actions at the EU level and member state level.

Slightly less-than-half of the population who should be covered by screening (according to the Recommendation itself) actually are. Meanwhile, less-than-half of examinations performed as part of screening programmes actually meet with all the stipulations of that Recommendation.

Yet findings in both Europe and the US strongly suggest that lung cancer screening works. There is hard evidence, although debate continues about the best way to implement screening of this kind, and even how to properly evaluate ‘cost effectiveness’ - who should decide?

Of course, guidelines could help to tether costs, by bringing in improvements to the efficiency of screening methodologies and, thus, programmes themselves.

Cost-effectiveness questions arise whenever population-wide screening is considered, especially in relation to frequency and duration. Yet, the potential benefit of low-dose CT lung cancer screening would almost certainly see an improvement in the lung cancer mortality rate in Europe.

Stakeholders are aware that screening in cancers also has potential harms. These include radiation risks (increased risk of other cancers), identification of often harmless nodules, which could lead to further evaluation (including biopsy or surgery), unnecessary fear in the patient and those close to him or her, and the aforementioned over-diagnosis and possibly subsequent treatment of cancerous cells that would cause no ill effects over a lifetime.

Often, malignant small lesions are found that would not grow, spread, or cause death. This could lead, again, to over-diagnosis or over-treatment, bringing about extra cost, anxiety and ill-effect (even death) caused by the treatment itself.

On the other hand screening can help to ensure that surgery (for example, in the case of the early stages of lung cancer) can continue to be the most effective treatment for the disease. As it stands, most patients are diagnosed at an advanced stage - usually non-curable.

Among recommendations currently being discussed in European forums are the setting of minimum requirements, which should include standardised operating procedures for low-dose imaging, criteria for inclusion (or exclusion) for screening.

Aside from lung cancer, many member states have been and are planning, piloting or implementing population-based screening programmes for other cancers, such as breast (again), cervical and colorectal.

But barriers often exist in areas such as access to screening and quality assurance. Other issues include the need for well-controlled introduction of any recommended programmes and updating those tests that are already running.

Governance in all screening programmes needs political as well as stakeholder commitment to agreed screening policies. These are currently lacking. Europe needs common targets, coupled with legal, fiscal and organisational frameworks to place and update programmes. The EU leadership should be taking a lead, here.

Performance and outcomes of screening programmes need to be continuously monitored, but among the importance aspects is equitable access to programmes.

The EU’s Cancer Control Joint Action (Cancon), which came to an end in May of this year, states that: “there is untapped potential for cancer prevention by extending population-based screening to new cancer sites”.

And they should know. Its published guide represents the main delivery of the joint action, with quality improvement of cancer care at the heart of its European Guide on Quality Improvement in Comprehensive Cancer Control.

The Guide aims to help to reduce not only the cancer burden throughout the EU but also the inequalities in cancer control and care that exist between Member states. it is targeted at governments, parliamentarians, healthcare providers and funders, as well as cancer care professionals at every level.

All would do well to read it, here.

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