Listening to our breath: doctors ask for mandatory CT scans for lung cancer
Computed tomography should be included in the system of diagnosing lung cancer in Russia, doctors and patients believe. At present, there is no CT scan among the mandatory tests for detecting the disease, but there are X-rays and fluorography. But, as experts say, these studies do not effectively detect lung cancer at an early stage, unlike CT. How necessary such a measure in the system of state guarantees and what funding it may require - in the material "Izvestia".
How they propose to improve diagnostics
The Ministry of Health was asked to add screening for lung cancer using low-dose CT scanning to the state guarantee system by specialists from leading medical organizations treating this disease, as well as representatives of the All-Russian Patients' Union. Their letter to the Ministry was read by Izvestia.
Now, they reminded, diagnosis of lung cancer is carried out with the help of fluorography or radiography, but these studies do not allow to detect small tumor foci.
"In 2023, the efficiency of detecting pathological changes in chest fluorography was 0.017%," the appeal states. - Lung cancer is one of the main causes of mortality of cancer patients. Five-year survival rate directly depends on the stage of the disease. Thus, at the initial stage it reaches more than 80%, while at the fourth stage - 6%".
The letter also notes that in about 70% of patients with lung cancer, the disease is now detected at the third stage, "when radical methods of treatment are no longer applicable."
"As a consequence, the most promising direction for early diagnosis of lung cancer with proven effectiveness is low-dose computed tomography," the letter to the ministry reads. Its authors sent a similar appeal to the State Duma Committee on Health Protection.
In particular, they propose to introduce CT scanning into the system of state guarantees from 2025, which would be carried out during medical examination of patients from risk groups - at the age of 50-75 years.
The authors of the appeal refer to the data of the Center of expertise and quality control of medical care of the Ministry of Health, according to which screening for lung cancer with CT scanning will increase the detection rate of the disease by almost 10%, increase the proportion of detected malignant neoplasms of the first stage by 5.3-8.3%, reduce one-year mortality by 7.8-11.3% and prevent up to 5.3 thousand patient deaths.
The appeal, in particular, signed by the chief freelance thoracic surgeon of the Ministry of Health Peter Yablonsky. "Izvestia" he reminded that the only serious factor that affects the survival rate of patients with lung cancer is the stage at which the disease is detected. Thus, the five-year survival rate for lung cancer at the first stage is up to 92%, at the second stage - up to 60%, at the third - 36%, and at the fourth stage - no more than 10%.
- It is more effective and cheaper to introduce screening for lung cancer using CT scanning, as initial treatment of a patient in the fourth stage is 157% more expensive than therapy of a patient diagnosed at the initial stage," he said.
Experts interviewed by Izvestia agreed with the arguments of the letter's authors.
- If we introduce low-dose CT everywhere and diagnose cancer more often, but at earlier stages, the survival rate of such patients will be much higher, - said Maxim Astrakhantsev, the chief doctor of the clinic of the Federal Network of Expert Oncology "Euroonco" in St. Petersburg. - If now we diagnose 100 cases of lung cancer and only 50% of them survive for one year, then with the improvement of diagnostic methods we will diagnose 300 cases of lung cancer, but 80-90% of them will survive in the first two years of life.
"Izvestia" sent a request to the Ministry of Health, the State Duma and the OMC Fund with a request to confirm receipt of such proposals from the medical community and evaluate them.
How effective CT is in diagnosing lung cancer
Over the past ten years, pilot projects on lung cancer screening with CT scanning have appeared in a number of Russian regions, the authors of the letter reminded.
"For example, as a result of the introduction of such an approach in Krasnoyarsk Krai, the detection rate of the disease increased from 0.039 cases per 1,000 people examined using fluorography to 17.1 cases per 1,000 people examined using low-dose computed tomography," they noted.
Ruslan Zukov, chief physician of the Krasnoyarsk Kryzhanovsky Krasnoyarsk Regional Clinical Oncology Dispensary (also one of the authors of the letter) told Izvestia that this region launched such a program in 2015.
- Krasnoyarsk Krai had quite high rates of lung cancer prevalence, so we got involved in active work to develop a screening program. First, we calculated the losses and feasibility of mass use of low-dose computed tomography, then we applied with them to the Compulsory Medical Insurance Fund for the region. We were allocated several hundred quotas for low-dose CT scans," he said. - But the pilot screening project was conducted only in Krasnoyarsk, as CT scanners at that time were in sufficient quantity only in the capital of the region.
Since 2019 in Krasnoyarsk Krai such a methodology has been introduced in the territorial program of dispensary screening of the adult population, Ruslan Zukov said.
- At first, we conducted screening with CT for men 55 years and older who have been smoking for 30 years or more. Then we added women to the screening and lowered the criteria to 20 years of smoking," he added.
According to the expert, from 2015 to 2023, the detection rate of lung cancer in the region at the first-second stage increased from 24% to 33-34%, while the Russian average is at 27-28%. In addition, exemplary results were also achieved in terms of five-year survival rate of patients: from 41.8% in 2015 to 45.7% in 2023.
How much it costs to introduce a new method
The Russian healthcare infrastructure is ready for the widespread introduction of such screening, the authors of the letter are confident.
"The introduction of this approach will not require the purchase of additional CT machines," the letter says. - The total number of CT machines has increased in recent years. For example, in 2020 there were 2,035 of them in the health care system, and in 2022 - almost 3 thousand."
But the implementation of the proposal may require additional funding - 1.26-2.65 billion rubles.
Ruslan Zukov emphasized that the socio-economic benefit of lung cancer screening with CT scanning lies in lives saved and cost savings.
- A course of immunotherapy costs the budget about 300 thousand rubles. Comprehensive genomic profiling costs about Br400 thousand. Determination of the molecular portrait of the tumor for targeted therapy - Br100 thousand, - he reminded. - If we add up the costs of treatment of patients with advanced stages of lung cancer, we get a very large sum, because they need systemic drug treatment.
The specialist added that the treatment of lung cancer in the early stages does not require so many expensive procedures and is much cheaper: at the first and second stages, local methods of fighting the tumor - surgery and radiation therapy - are mainly used.
