Healthcare (Jul 2023)

Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation

  • Daniela Amicizia,
  • Maria Francesca Piazza,
  • Francesca Marchini,
  • Matteo Astengo,
  • Federico Grammatico,
  • Alberto Battaglini,
  • Irene Schenone,
  • Camilla Sticchi,
  • Rosa Lavieri,
  • Bruno Di Silverio,
  • Giovanni Battista Andreoli,
  • Filippo Ansaldi

DOI
https://doi.org/10.3390/healthcare11142085
Journal volume & issue
Vol. 11, no. 14
p. 2085

Abstract

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Lung cancer is the leading cause of cancer-related deaths in Europe, with low survival rates primarily due to late-stage diagnosis. Early detection can significantly improve survival rates, but lung cancer screening is not currently implemented in Italy. Many countries have implemented lung cancer screening programs for high-risk populations, with studies showing a reduction in mortality. This review aimed to identify key areas for establishing a lung cancer screening program in Italy. A literature search was conducted in October 2022, using the PubMed and Scopus databases. Items of interest included updated evidence, approaches used in other countries, enrollment and eligibility criteria, models, cost-effectiveness studies, and smoking cessation programs. A literature search yielded 61 scientific papers, highlighting the effectiveness of low-dose computed tomography (LDCT) screening in reducing mortality among high-risk populations. The National Lung Screening Trial (NLST) in the United States demonstrated a 20% reduction in lung cancer mortality with LDCT, and other trials confirmed its potential to reduce mortality by up to 39% and detect early-stage cancers. However, false-positive results and associated harm were concerns. Economic evaluations generally supported the cost-effectiveness of LDCT screening, especially when combined with smoking cessation interventions for individuals aged 55 to 75 with a significant smoking history. Implementing a screening program in Italy requires the careful consideration of optimal strategies, population selection, result management, and the integration of smoking cessation. Resource limitations and tailored interventions for subpopulations with low-risk perception and non-adherence rates should be addressed with multidisciplinary expertise.

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