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In this keynote lecture I will provide an overview of the current European trials, debate the position where we are now on these 3 aspects, and provide detailed data from the NELSON-trial, the largest EU-lung cancer screening trial. There must be a reasonable balance between costs and benefits and measures must be taken to ensure that implementation will not lead to substantial unintended effects (such as widespread inequality, or increased smoking due to a health certificate effect or false reassurance by the test result). Secondly, any adverse effects must be limited in nature: the level of overdiagnosis and the side-effects need to be estimated and expressed in terms of quality-adjusted life-years gained. There must be substantial positive health outcomes in terms of additional years of life and a significant increase in treatment options. The newest criteria for early detection are therefore unambiguous. Early detection and prevention at public level does not guarantee effective prediction at an individual level, and to achieve positive outcomes we often need to implement programs for large groups of people, only some of whom will benefit. When considering whether lung cancer screening could or should be made available to the population, stringent standards must be applied. In Europe, 5 population-based RCTs of lung cancer screening have now completed their recruitment with almost 30,000 enrollees.
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In the US, the National Lung Screening Trial (NLST) was the first large-scale lung screening project ever to show that offering lung (CT) screening to high risk persons lead to a significant 20% lung cancer mortality reduction (and 6.7% all-cause mortality reduction at a median 6.5-years of follow-up). With the new low-dose multi-detector computer technology available in the past decade, lung cancer screening may play an important role in reducing lung cancer mortality and morbidity in high risk populations. At the same time, millions of men and women are presently at very high risk of developing lung cancer. effective ways to have smokers quit and effective ways to prevent adolescents to start smoking, are crucial to stop the epidemic, both in Europe and other parts of the world.
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