Lung health checks in car parks?

Lung cancer is a tumor with a bad prognosis: On average, only one in five patients survives the first five years after diagnosis.[1] As is the case with all cancer types, the prognosis depends on the stage at which the disease is detected. Patients have a better chance of survival if the cancer is discovered at stage 1 or 2 – or at least well before the first symptoms arise.

Several studies have already shown that lung cancer screening with low-dose computed tomography (LDCT) scans can prolong life. Back in 2011, the National Lung Screening Trial in the USA showed a reduction in cancer-specific mortality in high-risk patients. The more recently published European NELSON trial came to the same conclusion: A decade after the screening program started, death rates due to lung cancer amongst smokers and former smokers who were examined with an LDCT scan were 24% lower for men and 33% percent lower for women, compared with the control group that was not screened.[2] Similarly, the German LUSI study and the ITALUNG study from Tuscany indicate reduced mortality from lung cancer amongst patients who received LDCT screening.[3]

The UK Lung Cancer Screening Trial paved the way for showing the relevance of screening programs in the UK. The trial included 3,968 people in Liverpool and Cambridge, all in the 50–75 age group. Around 75% were male and the average age was 68. For all participants, the risk of developing lung cancer within five years was assessed as particularly high. Between October 2011 and February 2013, about half (1,987 participants) were examined with a CT scan. The remaining participants received the usual care provided by the NHS, but no CT scan. Each patient was observed and monitored for seven years. During this period, 86 cases of cancer were detected in those in the screening program, while only 75 cases were detected in patients who received the standard medical care. The result was also interesting with respect to mortality: 46 of the patients who received no CT examination died within a period of seven years, while only 30 of those from the screening program died.[4]

Founded in 1948, the National Health Service (NHS) is still a publicly funded state health system today. Unlike e.g., in Germany, the UK has no statutory health insurance. The British health system is based on the concept of the welfare state, which the British MP William Beveridge set out in the Beveridge Report. That is why the public health system is funded by tax revenue and nearly all medical services in the UK are free.

Thirteen percent of all cancer patients in the UK have lung cancer [5], and around 48,500 people receive this diagnosis each year.[6] The number of smokers in the UK has decreased significantly in the last few years, but cigarette consumption still costs smokers more years of life than any other influencing risk factor. Therefore, the overarching and long-term plan of the NHS is to protect those sections of the population that are most at risk – first and foremost smokers. The aim: By 2028, an additional 55,000 people each year will survive for five years or more after their cancer diagnosis.[7]

Considerable efforts are being made to achieve this ambitious aim. For example, screening programs are to be expanded by establishing Rapid Diagnostic Centres throughout the country. These will allow patients with relevant symptoms to be examined quickly without long waiting times.

One example of this is Tin Filter technology, which is fitted in all SOMATOM go. scanners used in the Manchester program. During a scan, the X-ray tube produces an energy spectrum that depends on the anode material. The Tin Filter filters out low-energy photons so that they don’t reach the patient. This means that they don’t affect the total effective dose, fewer artifacts occur, and the image quality is better.

Siemens Healthineers made another major breakthrough in 2021 with the market launch of the first photon-counting CT scanner: NAEOTOM Alpha. The new system produces images that, even to the naked eye, look sharp and more detailed than images from a conventional CT scanner. This is because the detector directly transforms the photons’ energy into electrical signals. This provides high spatial resolution, and the precise allocation of the photons reduces the dose required and minimizes image noise.

The battle against cancer – as shown by the efforts of the Cancer Alliance areas in England – can only be won if we work together. Due to the abnormal situation caused by the COVID-19 pandemic, screening appointments have slipped a long way down the list of priorities for many people. That is why many experts describe cancer as another pandemic – one that claims many more lives than COVID-19. The World Economic Forum will therefore be addressing the topic of cancer screening at its annual meeting in May.