Screening for lung cancer makes sense for smokers – only Germany is lagging behind

Screening for lung cancer can reduce the risk of death for long-time smokers. More and more studies show that. US researchers have just presented encouraging results on chances of survival. German experts also see great potential in an early detection program for risk patients. The introduction of such a screening in Germany is on the way, but the decisive step is still pending.

No other form of cancer kills more people in this country than lung cancer, with more than 44,000 deaths in 2020. The main risk factor is smoking: 90 percent of lung cancer cases in men are attributable to it. Since those affected have symptoms such as a persistent cough and weight loss relatively late, the chances of survival after a diagnosis are comparatively poor - according to the Robert Koch Institute, they are less than 20 percent within 10 years. By the time the cancer is discovered, it is usually too big to be removed or cured.

Regular examinations with so-called low-dose computed tomography (LDCT) - experts call this screening - physicians can detect the tumors at an earlier stage. This increases the chances of survival because the tumor can still be surgically removed relatively often. Rudolf Kaaks, epidemiologist at the German Cancer Research Center (DKFZ), assumes that screening reduces lung cancer mortality by "slightly less than 20 percent". This roughly corresponds to the effect of mammography, the screening for breast cancer in women.

A large study from the Netherlands and Belgium came to a similar conclusion. According to this, the risk of lung cancer dying within 10 years is reduced by 24 percent through screening.

In addition, researchers at Mount Sinai Hospital in New York just recently reported that patients whose cancer was detected early by CT screening had an 80 percent chance of being alive 20 years later. They had evaluated the data of 1285 patients.

"These are convincing data from long-term observation," says Torsten Bauer. He is President of the German Society for Pneumology and Respiratory Medicine (DGP), which is strongly committed to nationwide lung cancer screening for high-risk patients in Germany.

The so-called Federal Joint Committee (G-BA) has to decide on this. However, the committee, which brings together doctors, health insurance companies and clinics, is still waiting for an ordinance from the Federal Ministry for the Environment, as a G-BA spokeswoman said on request. Only then can the deliberations begin. They may last a maximum of 18 months.

A report by the Institute for Quality and Efficiency in Health Care (Iqwig) commissioned by the G-BA comes to the conclusion that "for (former) heavy smokers, the benefits of low-dose CT lung cancer screening outweigh the harm".

In a report by the Federal Office for Radiation Protection (BfS), in which Kaaks was also involved, it says: "Weighing the benefits and risks shows that early detection of lung cancer using LDCT reduces lung cancer mortality in smokers, but on the other hand also with radiation risks and unwanted ones effects.”

Among other things, the BfS points out that there is a risk of false-positive results, which can be stressful for those affected. "In order to ensure the best possible benefit-risk ratio, strict conditions and requirements must be imposed on early detection of lung cancer using LDCT."

Should the screening be introduced in Germany, which Bauer and Kaaks assume, it should only be offered to a narrowly defined group of people: Older people, for example from the age of 50, who have smoked heavily for decades. The exact requirements for this have not yet been determined. Kaaks assumes that these people should then go for a CT scan every one to two years.

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