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Longkanker Screening

Lung Cancer: The evidence. Cancer killer number 1Serious public health problem (economic / health resourses)> 375,000 new cases in the EU each year1.8 million deaths worldwide8.000 new cases / year in the Netherlands. Lung Cancer: The evidence. Succes of smoking cessation programmes is limite

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Longkanker Screening

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    1. Longkanker Screening

    2. Lung Cancer: The evidence Cancer killer number 1 Serious public health problem (economic / health resourses) > 375,000 new cases in the EU each year 1.8 million deaths worldwide 8.000 new cases / year in the Netherlands

    3. Lung Cancer: The evidence Succes of smoking cessation programmes is limited : quit rate 10-20% Increasing number of LC cases in ex-smokers (in U.S. >50%)

    4. Lung Cancer: The evidence > 80% has local or distant metastatic disease 5 yr survival less than 15% No improvement in survival during last decades

    5. Lung Cancer: The evidence Improvements in long-term survival minimal (except post-op chemotherapy, and some by concurrent chemo-RT) Improvements in survival of late stage patients significant but still short (months) Costs of care of last year of life of disseminated lung cancer is high and will become much higher in near future: prevention/early detection attractive for health care insurance companies ?

    6. Screening trials in the 70s The randomised clinical trials with CXR showed no reduction in lung cancer mortality Based on these negative results professional health organisations do not recommend screening for lung cancer

    7. But anno 2005 things have changed With the advent of the low dose multislice CT technique, there has become renewed interest in lung cancer screening ..and there is consensus that the sientific evidence from the trials conducted in the 70s is not solid enough to conclude that screening is ineffective..

    10. Current Position Statements: ACS The ACS continues to recommend that CT screening should not be performed in asymptomatic at risk personsbut if people choose on their own to be screened: They recommend: informed decision making CT screening should be done in experienced centers linked to multidisciplinary groups for diagnosis and follow-up

    12. Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) A Randomised Clinical Trial For Lung Cancer Screening in high risk subjects

    13. Key Investigators EMC Rotterdam: Dr van Klaveren (PI) Dr de Koning Drs van Iersel Prof Habbema UMC Utrecht: Prof Mali Dr Prokop Prof Lammers AZ Groningen: Prof Oudkerk Prof Groen KG Haarlem: Drs Scholten Dr Weenink UZ Gasthuisberg Leuven: Prof Nackaerts Prof Verschakelen

    14. Sponsors ZONMW KWF Kankerbestrijding RvvZ Siemens AG ROTS G.Ph. Verhagen Stichting Erasmus Trust Fund Vlaamse Liga tegen Kanker Belgische Federatie tegen Kanker

    15. Primary Objectives to establish if lung cancer screening by low-dose spiral CT will lead to a decrease in lung cancer mortality of at least 20% to estimate the cost-effectiveness of lung cancer screening in the Netherlands

    16. Design

    17. Power calculation

    18. Results first recruitment

    20. Results Second recruitment

    21. Total recruitment results and power

    22. National Lung Screening Trial NCI study 3 Annual Spiral CT screening vs CXR Accrual completed in 2004: 53,000 participants Follow-up through 2009

    23. Conclusion Two large RCTs ongoing (NLST and NELSON) Outcome of these trials will have great impact on the treatment and management of lung cancer in the near future

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