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Eur Radiol. 2020 Feb 12. doi: 10.1007/s00330-020-06727-7. [Epub ahead of print]

ESR/ERS statement paper on lung cancer screening.

Author information

1
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany. hans-ulrich.kauczor@med.uni-heidelberg.de.
2
Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland.
3
Department of Pneumology, Klinikum Emil von Behring, Berlin, Germany.
4
Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy.
5
Intensive Care Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece.
6
Otto Wagner Hospital Vienna, Vienna, Austria.
7
S.E.N.A. s.r.o, Prague, Czech Republic.
8
Community Health Association Romania, Bucharest, Romania.
9
Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.
10
Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France.
11
Royal Brompton Hospital, London, UK.
12
, Holstebro, Denmark.
13
Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation.
14
Internal Medicine F, Rabin Medical Center, Petah Tikva, Israel.
15
Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel.
16
European Lung Foundation, Sheffield, UK.
17
Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
18
Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.
19
Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal.
20
ELF Advocacy, Tipton, UK.
21
Radiology Department, Cochin Hospital, APHP, Paris, France.
22
Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.
23
Radiology, University Hospital of Antwerp, Edegem, Belgium.
24
Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.
25
Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands.
26
Pulmonology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium.
27
Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
28
Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA.
29
Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
30
7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece.

Abstract

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings. • For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.

KEYWORDS:

Carcinoma, bronchogenic; Cost-benefit analysis; Early detection of cancer; Lung neoplasms; Tobacco use cessation

PMID:
32052170
DOI:
10.1007/s00330-020-06727-7

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