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A study carried out by specialists from the Clínica Universidad de Navarrathe CIMA and the University of Pittsburgh reveals the importance of pulmonary emphysema as a risk factor in the development of approximately 30% of lung cancer cases. For this reason, the research recommends considering emphysema as a criterion for inclusion in general early detection programs, as it would increase the number of lung cancers diagnosed in time by around 40%, as they found in the sample of individuals studied. This would significantly improve the cost-effectiveness of screening plans for early detection of this tumor.

The results of two programs of study from the Clinic that support this premise have recently been published in two scientific articles in the highest impact journal of the specialization program: "American Journal of Respiratory and Critical Care Medicine"the official journal of the American Thoracic Society.

In fact, the specialists at the CUN's Pneumologydepartment apply these criteria in the preventive health check-ups they perform on their patients, starting at age 45 if they are or have been smokers.

The launch of screening in the U.S. at internship .

The United States is currently in the lead in the fight against lung cancer, the world's deadliest cancer. In recent days, the US administration has announced the implementation of an early detection program for this tumor. The plan involves annual screening of smokers and former smokers between 55 and 77 years of age who have smoked the equivalent of a pack a day for 30 years by means of a scanner (Computerized Axial Tomography, CAT scan) with leave radiation.

purpose The U.S. decision to implement a screening plan for the early diagnosis of lung cancer stems from the findings of a study conducted in the United States by the National Lung Screening Study (NLST). This work demonstrated in a large population sample (more than 50,000 individuals) that the performance of a chest CT of leave annual radiation dose in at-risk individuals managed to reduce mortality from lung cancer by at least 20%. CT in these individuals was able to detect lung tumors in their earliest stages and therefore at status of cure.

The high mortality rate of lung cancer is largely due to the fact that this tumor begins to show symptoms in very advanced stages of the disease, that is, when it cannot be operated on and treatment is effective in very few cases.

70,000 patients analyzed by IELCAP

The first programs of study on the efficacy of an annual CT scan in the at-risk population for the early detection of lung cancer was initiated 15 years ago by an international group of research centers, IELCAP. In Spain, Clínica Universidad de Navarra was the first center to participate in this study, in which more than 70,000 patients have already been analyzed.

The results of this work alerted us to the importance of applying this diagnostic test (the scanner of leave radiation) in a protocolized manner in order to subvert the mortality figures for lung cancer. The success rate of data was overwhelming: "between 80 and 85% of the tumors detected with this technique were found in stage 1 or early stage, when it is usual for 85% of these tumors to be found in stages 3 or 4. On the other hand, more than 80% of the lung cancer patients we have diagnosed with our early detection program are still alive 10 years later," explains Dr. Javier Zulueta. Dr. Javier Zuluetadirector of the department of Pneumology and lead author of the first published article .

However, the proposal of applying a CT scan in a generalized manner in the at-risk population raised a great deal of criticism from some quarters, especially from administrative and political circles. For this reason, the US administration decided to launch its own study to verify first-hand the high survival achieved in the IELCAP research by applying an annual preventive CT scan. In this official study they obtained the excellent results previously mentioned, with a confirmed reduction in mortality of at least 20%, although the reduction is probably much greater.

Refine criteria for inclusion in the program

programs of study current efforts are trying to further refine the criteria for the population that should undergo such screening programs so that the cost/effectiveness ratio of this test is higher. There is some concern that the plan applied in the United States does not have sufficient sensitivity to diagnose the maximum issue of incipient lung tumors.

Researchers at the Clinic and the University of Pittsburgh found that if they adopted only the NLST criteria in the samples of individuals studied, "we would lose as much as 39% of the lung cancers that we had diagnosed including emphysema as a complementary criterion," warns Dr. Zulueta.

COPD, a potential target for screening programs

goal With the aim of improving the diagnostic performance of screening programs, the Clinic's specialists have also focused on patients affected by COPD (Chronic Obstructive Pulmonary Disease), another of the respiratory diseases that causes the most deaths in the world and with a high risk of developing lung cancer. In a study led by Dr. Juan Pablo de Torresa pulmonologist at the Clinic, and also validated in COPD patients at the University of Pittsburgh, an easy-to-use scale was developed to identify COPD patients at high risk of developing lung cancer. The COPD Lung Cancer Screning Score would identify among COPD patients the best candidates for inclusion in screening programs.

"In Spain and in Europe we are not yet close to making the same decision as the United States, but given the drama of lung cancer, the one that causes the most deaths, and in view of the results obtained in research, it is very likely that similar decisions will be made in the future, so that in the near future the outlook for these patients could change drastically," stresses Dr. Zulueta.