Lung cancer prevention

Written by Mina Gaga, Pulmonologist, Director of the 1st Pulmonology Clinic HYGEIA

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Lung cancer is a very common neoplasm and is still the first cause of cancer death worldwide. It affects adults, mainly smokers, as well as people with occupational or other exposure or a family history of cancer. Sometimes it can also concern young people. It is important to make an early diagnosis, in the initial stages of the disease, as the treatment options are many and effective and the prognosis is better. In the early stages there are usually no symptoms. Some of the main symptoms of lung cancer are cough, chest pain, bloody sputum and shortness of breath. However, these are non-specific symptoms and in most cases appear late in the course of the disease, where therapeutic possibilities are limited

It is therefore essential to prevent lung cancer. Prevention can be either primarywhich means avoiding smoking and exposure to smoke and occupational or environmental carcinogens, so as to reduce the generative causes of cancer and prevent it from forming at all, or secondary. Secondary prevention refers to early diagnosis with screening in an asymptomatic population. Screening makes it possible to diagnose lung cancer in the early stages, so it can be treated radically and the chances of survival exceed 80%.

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In recent years, a better understanding of cancer biology and newer treatments have improved survival, even in advanced stages. But again, the prognosis is much better when the disease is in the early stages and so the cornerstone for improving survival is early diagnosis of lung cancer.

What does lung cancer screening mean?

When we talk about lung cancer screening we mean screening before symptoms appear. It is a procedure similar to the preventive screening for breast cancer, where preventive mammograms are done at regular intervals, or to the Pap-test which is also regularly performed to prevent uterine cancer. For lung cancer, large randomized studies in recent years have demonstrated the value of low-dose chest computed tomography (Low dose CT) for the early diagnosis of lung cancer in early stages.

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Who should be screened for lung cancer?

Active smokers who have a smoking history of 20 pack years, i.e. people who have smoked one pack a day for more than 20 years or people who have smoked 2 packs a day for 10 years (or half a pack for 40 years etc.) are candidates for screening. Also, ex-smokers, who have stopped smoking less than 15 years and have a smoking history of more than 20 pack-years, should be screened.

Screening programs include discussion and information of the individual who is included in the screening program, pulmonary assessment and clinical examination, low-dose chest CT and assessment of results by both radiologists and pulmonologists as well as by a multidisciplinary team (i.e. physicians and specialist health professionals of various specialties). . This is because any findings include shadows in the lung that must be evaluated but also findings from the heart and great vessels, from the upper abdomen and any organ that is in the imaging field. The programs that have the best results are combined with smoking cessation programs, psychological support with the existence of the interdisciplinary team. If there are no pathological findings in the first check, then the recommendation is to repeat the x-ray after 1.5-2 years. If there are, then the treatment of the patient diagnostically and therapeutically, is individualized based on the international guidelines and the recommendations of the group of experts.

In our country, with funding from the EU and the Ministry of Health, a lung cancer screening research program is running and it concerns women and a population that hardly uses health facilities.

At Hygeia Hospital, a new lung cancer screening program has been introduced. In this program, there is an initial briefing and evaluation by a pulmonologist, LC-CT is performed and evaluated by a team of radiologists, pulmonologists and thoracic surgeons, as well as any other specialty, if necessary.

The program can be combined with a smoking cessation program for those who wish to do so – and this is recommended by international guidelines based on documented scientific data.
The aim is the timely control and follow-up by specialized medical personnel so that there is a timely treatment of any problem that may arise and corresponding support.