First Ibero-American Summit on Lung Cancer Screening
Archivos de Bronconeumología
First Ibero-American Summit on Lung Cancer Screening
Sergio Benitez, Franzel Delgado, Venceslau Hespanhol, Iris Boyeras, Sebastian Lamot, Gustavo Faibischew, Francisco Suarez, Lucia Viola, Maria Rodriguez, Juan Carlos Trujillo, Luis M. Seijo
Lung cancer is the leading cause of cancer deaths worldwide with an incidence–mortality ratio close to one.1 Although it affects non-smokers as well, smoking remains the main cause of lung cancer, with a biological gradient showing a higher risk associated with heavier tobacco use. An increase in cases and deaths related to this disease is expected in the coming years. Low-income countries are the most affected, experiencing higher incidence and mortality rates from lung cancer.2
In recent years, several scientific studies, registries, and meta-analyses have unequivocally shown that lung cancer
screening of high-risk individuals using low-dose chest computed tomography (LDCT) significantly reduces mortality from this disease. The benefit of screening is expected given that most lung cancers found incidentally are inoperable and costs of systemic therapies, which at best prolong life, are significantly higher than those of a successful surgical resection.
Lung cancer screening programs should meet certain minimum standards, including at least a tobacco cessation program, a referral system for patients with non-respiratory comorbidities, access to LDCT and an interdisciplinary lung nodule committee.
There are limitations and potential dangers associated with the implementation of these programs, mainly related to the false positive rates associated with LDCT, potential overdiagnosis, and complications associated with invasive procedures. In regions with a high incidence of tuberculosis, for example, and in much of Latin America, granulomatous or scar-related nodules might increase the false positive rate and raise the risk of complications related to invasive management. However, two publications show that the implementation of lung cancer screening programs in populations with a high incidence of tuberculosis yields similar results to the initial studies in terms of diagnoses and biopsies performed.6,7 In other words, lung cancer screening programs demonstrate good external validity even in contexts that differ from the original studies.
