Pilot Programme for Early Detection of Lung Cancer Proves Its Worth

The pilot programme for early detection of lung cancer in Spain, which began a year and a half ago, has revealed its initial results, which are quite promising. They suggest that this screening system, aimed at detecting tumours in at-risk populations while they are still asymptomatic and operable, has proven its worth, offering a five-year survival rate of 80% or more upon diagnosis.

The efforts of the Spanish Society of Pneumology and Thoracic Surgery (Separ), the project's promoter with support from the Spanish Association Against Cancer, patient organisations, and other leading scientific societies involved in combating this tumour (oncologists, radiologists, pathologists, and family doctors), have enabled twelve hospitals across six autonomous communities, coordinated with an equal number of health centres, to conduct diagnostic tests on 658 smokers or former smokers over 50 years old without symptoms since November 2023, in search of signs of lung cancer.

The outcome is that the scans and spirometry tests conducted allowed for the detection of early-stage and localised tumours in 21 cases, representing 3.2% of the total. This will enable these individuals, who otherwise might not have known their diagnosis until the disease reached an advanced stage, to undergo treatments with high expectations of success and survival.

Doctors Juan Carlos Trujillo and Luis Seijo, project coordinators, indicated that the results are "very positive," as they demonstrate that the screening model they have implemented, despite still being in its infancy, achieves "a significant percentage of early-stage lung cancer detection." In fact, the proportion is at the higher end of similar international experiences, which detect asymptomatic tumours in their preventive checks in 1% to 4% of reviewed cases.

Of the remaining patients screened, with an average age of 61 years and smokers or former smokers of at least one pack daily for 20 years, the CT scan was completely clear in 77% of cases, and the results of the remaining 19% were inconclusive, requiring follow-up and additional studies. The tests also detected coronary calcifications in 52%, emphysema in 17%, and other respiratory pathologies in smaller percentages.

Separ, with its initiative, seeks to improve the chances of defeating the disease and demonstrate to health authorities the feasibility and profitability of implementing this type of screening, not just experimentally and for a few, but for all Spaniards in the risk group. The initiative, currently only a pilot test, if eventually consolidated and included in the National Health System's service portfolio, as is already the case with breast or colon screenings, would significantly increase survival rates for the tumour that causes the most deaths each year in this country, approximately 23,000, one death every twenty minutes.

An effective early detection system for lung tumours would revolutionise the fight against this pathology, which currently has a five-year survival rate of 15% because, in the vast majority of cases (seven out of ten), the diagnosis comes at a very advanced stage of the disease, where surgery, the most effective technique for achieving a cure, is no longer advisable or possible due to the excessive development of the cancer or even the onset of metastasis.

While health authorities decide whether to institutionalise and extend this screening to all at-risk Spaniards, Separ and its allies will continue with the pilot project. Their aim is to significantly increase the hospitals, health centres, and autonomous communities participating in the programme by September, to increase the current 80 citizens screened per month to at least 200. Their plan is to conduct examinations over the next five years and then follow up with the screened patients for the subsequent five years.

Given the limited possibilities of this pilot, the criteria for candidate selection are very strict: smoking and age. Candidates for the programme are citizens between 50 and 75 years old, who smoke or have smoked in the last 15 years and have consumed on average no less than one pack of cigarettes a day. They can reach the screening through participating health centres or hospital specialists.

The main tool of Cassandra, the name of the experiment, is a low-dose chest CT scan to try to detect malignant pulmonary nodules, complemented by a spirometry device to determine the citizen's lung capacity and strength. It is hoped that in the future, blood tests can be conducted to search for tumour biomarkers that predict the disease even before nodules appear, but there is currently no budget for this. The programme is completed with a smoking cessation plan, which 97% of the screened individuals who still smoked have already joined.