Kauczor Hans-Ulrich, Baird Anne-Marie, Blum Torsten Gerriet, Bonomo Lorenzo, Bostantzoglou Clementine, Burghuber Otto, Čepická Blanka, Comanescu Alina, Couraud Sébastien, Devaraj Anand, Jespersen Vagn, Morozov Sergey, Nardi Agmon Inbar, Peled Nir, Powell Pippa, Prosch Helmut, Ravara Sofia, Rawlinson Janette, Revel Marie-Pierre, Silva Mario, Snoeckx Annemiek, van Ginneken Bram, van Meerbeeck Jan P, Vardavas Constantine, von Stackelberg Oyunbileg, Gaga Mina
Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland.
Eur Respir J. 2020 Feb 12;55(2). doi: 10.1183/13993003.00506-2019. Print 2020 Feb.
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
在欧洲，肺癌是最常见的癌症之一，位列第三，但仍是最大的杀手。自2015年欧洲放射学会和欧洲呼吸学会首次联合发布关于肺癌筛查（LCS）的白皮书以来，许多新的研究结果相继发表，相关讨论也显著增加。因此，这份更新后的专家意见对肺癌筛查试验的证据进行了叙述性、非系统性综述，并描述了当前肺癌筛查的实践情况以及迄今尚未得到充分关注的方面。接触潜在参与者（高危人群）、进行最佳沟通和共同决策将是关键的起点。此外，基础设施、流程和质量保证的标准至关重要，包括促进戒烟、利弊、过度诊断、质量、最小辐射暴露、阳性筛查结果的管理定义以及与相应行动相关的偶然发现，还有成本效益。这需要一个多学科团队，成员包括肺病学和放射学专家以及胸科肿瘤学家、胸外科医生、病理学家、家庭医生、患者代表等。欧洲放射学会和欧洲呼吸学会一致认为，欧洲的卫生系统需要进行调整，以使公民能够从有组织的流程中受益，而不是从无监督的举措中受益，从而实现肺癌的早期诊断并降低死亡率。现在是时候设立并开展示范项目了，这些项目除其他要点外，应侧重于方法学、标准化、戒烟、健康生活方式教育、成本效益以及建立中央登记处。
