In its report, published this Thursday, on lung cancer screening, the Federal Center of Health Care Expertise (KCE) does not mince its words. Although he must admit that screening has advantages to the extent that it can save lives, the KCE does not hesitate to speak of disadvantages.serious”, “significant” or “considerable”, “which must be carefully weighed by the authorities and then by the people at high risk themselves”.
Explanations from the experts responsible for examining the effectiveness, safety and cost-effectiveness of a possible systematic screening program to be implemented in Belgium.
A promising new treatment for bladder cancer: “An unprecedented breakthrough”
1. The state of play and the context
Lung cancer is one of the most common cancers and the leading cause of cancer mortality in our country. According to the Belgian Cancer Registry, 9,192 cases of lung cancer were diagnosed in Belgium in 2021, 5,675 (62%) in men and 3,517 (38%) in women. Between 2006 and 2020, its incidence increased by 84% in women, while it decreased by 19% in men.
As this cancer most of the time does not cause any symptoms at an early stage, the disease is frequently diagnosed at an advanced stage, which limits treatment options and reduces the chances of survival. Hence the desire, particularly expressed in certain neighboring countries, to regularly offer people at high risk of lung cancer, such as heavy (ex-) smokers, screening using a low-dose CT-scan. Low-dose computed tomography (LDCT), which could be used for this systematic screening, allows for less invasive treatment and lowers the number of deaths. “A review of the literature shows that lung cancer screening effectively reduces lung cancer mortality by 21% and general mortality by 5% among people who participate in it. specify the authors of the report. Applied to Belgium, our analysis reveals that, if 1000 people at high risk participate in three rounds of screening, this will have saved 3 lives 10 years later”.
During and after cancer, physical exercise is a major asset in the healing process: “It can reduce the risk of recurrence by 20 to 40%”
2. The limitations and disadvantages of screening
If this screening does indeed make it possible – to a certain extent – to reduce mortality, it nevertheless presents certain disadvantages, as the KCE points out. “For some screening participants, the result is indeterminate (inconclusive); a new examination is then carried out. Sometimes, during additional invasive tests such as biopsies, bronchoscopies or even surgical procedures, it may turn out that the initial screening result was incorrect (false positive). In addition to the unnecessary stress they cause, these procedures can sometimes lead to complications”.
Then there is the problem of overdiagnosis and overtreatment: “Csome patients are treated for tumors that would have progressed very slowly or not at all in the absence of screeningemphasize the experts, and which did not present a real danger because the patient would have died of another illness or old age before they became problematic”.
And that’s not all. As the KCE further indicates, it frequently happens that a scan of the entire thorax is accompanied by the fortuitous discovery suspicious lesions, which often leads to additional tests being carried out. In this case, “it is currently not yet clear whether these incidental findings ultimately represent an advantage for the participants, or rather a disadvantage”.
“In Belgium, we have relatively high exposure to cancer risk factors”
A certain number of rapidly progressing cancers will also appear between two screenings. “These are “interval cancers, warns the KCE. Care must therefore be taken to ensure that participation in screening does not create a misleading impression of security.”.
Finally, you should know that “repeated low-dose computed tomography (LDCT) scans also carry a low long-term risk of cancer due to radiation exposure”, underlines the report.
3 The cost-effectiveness ratio
As to whether, taking into account all the advantages and disadvantages, organized preventive screening for lung cancer in Belgium would be a profitable investment, the KCE calculated that it would lead in our country to an incremental cost-effectiveness ratio of €18,530 per year of life gained in good health. “A certain number of elements have a major impact on this cost-effectiveness ratio, such as the number of overdiagnoses, confidential discounts on certain anticancer treatments, the costs incurred to reach and invite the target group and the number of participants in screening, details the KCE. Lung cancer screening can therefore be cost-effective if the authorities are prepared to pay more than €20,000 per year of life gained in good health”.
Also, in the process, the KCE invites political decision-makers to “make a carefully considered choice based on this data and any other factors”. Such as the screening to determine to what extent the target group would be willing to participate in screening after having been properly informed of all the advantages and disadvantages. Or the upstream assessment of the impact of screening on the health budget and on the healthcare system (in terms of availability of providers and the necessary equipment).
And to recall – if necessary – by way of conclusion that “The most effective and cost-effective measure to prevent lung cancer is to stop smoking or, better, never to start”.
