Pilot study for a population-based lung cancer screening in Flanders (Belgium): ready for roll-out?

Background

Lung cancer is the leading cause of cancer related deaths worldwide. Lung cancer has a high mortality because it is mainly detected at an advanced stage. Lung cancer screening with low-dose CT scan can reduce lung cancer related mortality. At the European level, member states are encouraged to set up pilot projects and to investigate how such programs can take shape. For that reason, the University Hospital Antwerp and the Antwerp University launched a pilot project for lung cancer screening in Flanders (www.zoralcs.be).

Methods

All inhabitants aged 55-74 years old in a region with six municipalities nearby Antwerp (n = 25,883) received an invitation letter to log in on a secured website and fill-out a short survey, including a risk-prediction model. GPs, pharmacists, local authorities and digital support centers were strongly involved. People who met the inclusion criteria were offered quit smoking support. CT scans were read by experienced thorax radiologists followed by an assessment via AI as second reader.

Results

5,272 citizens (20.4%) visited the website, of which 4,874 (92.5%) completed the survey and 1,390 met the inclusion criteria. After informed consent, 1,315 (94.6%) were eligible to make an appointment for a low-dose CT scan. Finally, 1,166 unique participants were scanned, 66% males, median age 66 years, 64% had quit smoking and almost half (48.5%) had a low educational level. No-shows were negligible (n = 7). 1,081 (92.7%) of the participants had no/small nodules and are re-invited after 12 months; while 64 (5.5%) had a low or intermediate risk and 21 (1.80%) had a high risk. Incidental findings were limited to 13 cases (1.1%). Participants showed overall great satisfaction with the different phases of the screening, such as friendly welcome, appropriate information, comfort during scan, result within an acceptable period, reassured after participation.

Conclusions

Population based lung cancer screening is feasible in Flanders (Belgium).

Key messages

• When quality can be assured, a population-based lung cancer screening seems feasible in Flanders, also reaching the target group of people with low educational level.

• A privacy-proof web platform and a risk-prediction model to select the target group are necessary and acceptable for low educational groups if support (e.g. digital support center) is available.