"Hunt" for 10,000 smokers to try to prevent lung cancer

34 thousand. Every year, around 80% of all new cases are diagnosed with lung cancer that is already advanced. And when the tumor cannot be removed with surgery, the chances of survival are reduced. For this reason Italy is at the forefront, within a European program, to recruit 10,000 strong smokers in the next two years. The identikit? Age between 55 and 75 years, with a smoking history of at least 30 packages per year. The volunteers will be included in a large study (which will see the recruitment of 24,000 people) with the aim of defining the best methods for lung screening, combining the most advanced techniques of Tac low-dose spiral radiation and measurements of specific biomarkers , through a simple blood test. An important project, to which family doctors will offer a decisive contribution, thanks to the direct and constant relationship with their patients. The announcement comes from the 36th National Congress of the Italian Society of General Medicine and Primary Care (SIMG) held in Florence.The initiative is part of a European multi-center funding project that includes 6 countries (Italy, Holland, Germany, England, France, Spain, ed.), Under the Horizon 2020 program, and offers Italy the opportunity to start in a gradual and controlled way pulmonary screening, through a network of reference centers that provide adequate coverage of the territory and, at the same time, a level of quality adequate to the standards currently achieved in the screening of other cancers: breast, cervix, colon -retto.

10 centers for the Italian Lung Screening Network

"The establishment of the Italian Pulmonary Screening Network (RISP) is the first step for the low-dose spiral CT to become a consolidated practice throughout the territory, on a par with mammography for the early diagnosis of breast cancer," stresses Ugo Pastorino, Director of Thoracic Surgery, IRCCS Foundation, National Cancer Institute of Milan: "We identified 10 centers to start the network, coordinated by the National Cancer Institute of Milan, which include IRCCS, hospitals and university centers, characterized by high levels of efficiency in the oncology field , to offer a service in 10 macro-territorial areas ". The network must guarantee all the activities foreseen in the European funding call, in particular the recruitment and selection of eligible candidates through a centralized structure, the collection of all the exams with TAC low dose spiral in a single data base and systematic control of technological quality and ade compliance with the international standards of each recruiting center.

"Thanks to the Net, we want to start a controlled system, which does not involve further disbursements to the national health service, already put to the test by the impact of the treatment of tumors", Pastorino continues: "The 10 centers involved share the same rules in the 'execution of the screening and have a high level of experience in radiology, surgery, oncology and in all services for the treatment of pulmonary pathology.They therefore have tools and staff ready to start the project quickly, without having to invest additional resources, to example, in training or in the purchase of equipment ".

The spiral CT reduces mortality up to 39%

Several studies conducted in the United States, Europe and Italy have shown that low-dose spiral CT screening in heavy smokers can result in a reduction in lung cancer mortality of between 20% and 39%. "This is a result far superior to that obtainable with mammographic screening, which is guaranteed by the National Health Service to all women between the ages of 50 and 69 – explains Pastorino -. Not only. The reading of the thoracic spiral CT today occurs in an almost completely automated way (through CAD, computer aided detection), so the radiologist only competes for an evaluation of critical cases. In mammography, however, the reading of the exams is still manual. Lung cancer screening, therefore, implies on the one hand costs, commitment of staff and shorter times, on the other an impact on the reduction of the most relevant mortality ".

A useful exam not only for lung cancer

The reticence, even on the part of many doctors, regarding pulmonary screening is due to the high mortality of heavy smokers for other diseases, especially cardiovascular or respiratory diseases, in particular, chronic obstructive pulmonary disease. "Today with the spiral CT, an exam that lasts a few seconds, we can also photograph the global risk for other diseases, for example by quantifying coronary damage with great precision", explains Claudio Cricelli, president of SIMG: "The risk of heart attack is high in presence of coronary calcifications. The number of lives saved can become really relevant with the spread of large-scale lung screening ".

The problem of "indeterminate nodules"

One of the challenges is the diagnosis of indeterminate nodules. Only 1% of these lesions actually turn out to be a lung tumor after basic analysis. It is essential to increase this percentage. For this reason, within the European project, a double reading of the result of the TAC by a local radiologist and a radiologist with decades of experience is planned. "In this way – explains Pastorino – the number of false positives is reduced, resulting in less stress for the people who undergo screening".

The new study

The European study will be launched in the spring of 2020. Volunteers presenting a negative TAC will be divided into two groups: 50% will repeat the test after one year and the other half after 24 months. "We want to show that those with a lower risk can be screened every two years," Pastorino continues: "The aim of the study is also to define the risk profile of smokers who have a positive or suspected CT scan, using biomarkers. Molecular testing identifies certain microRNAs in the blood, small molecules that regulate the production of proteins and control their growth mechanisms. This exam is able to differentiate the different risk profiles, allowing to activate personalized screening intensity programs ”."After the start of the first phase of the project, lung cancer screening will also be combined with tobacco cessation programs," concludes Cricelli: "Cigarette smoking is in fact responsible for 85-90% of lung cancers , for which primary prevention, intended as a structured support program for smoking cessation, still represents the most effective way to counteract the incidence of this disease and significantly reduce mortality ".

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