This Lung Cancer Awareness Month, Diva Fanian, Account Manager at Incisive Health, explores the benefits of lung cancer screening and the support people who are eligible for screening need to make it a success.
With more screening, comes a greater responsibility to support patients along the way
Cancer screening is a vital tool to help detect cancer at an early stage when there are more treatment options, offering people the best opportunity of living beyond their disease. Studies show that 90% of people believe that screening is 'almost always a good idea'. While screening programmes for common cancers such as breast, cervical and bowel are standard in many health systems, introduction of lung cancer screening lags behind. There are, however, more and more clinical studies making the case for the effectiveness of lung screening, influencing countries to introduce programmes for high-risk patients.
With all the discussion about the clinical benefit of lung cancer screening, we must remind ourselves that in order to be successful, people at risk of lung cancer need to be supported to attend screening appointments and be empowered to understand and act on the results. As we make our way through Lung Cancer Awareness Month, we wanted to explore the impact that screening programs can have on patient outcomes, but also recognise the importance of enabling and empowering patients who are navigating the screening system.
Making the case for screening
Late diagnosis of lung cancer limits treatment options for patients and increases the cost of care. Some 60 to 70% of lung cancer patients are diagnosed at an advanced stage in Europe, which limits their chances of survival. Lung cancer screening has shown to lead to a 20% reduction in mortality by detecting more lung cancers at stage 1 and 2 when they are more treatable.
This evidence is what has led several countries around the world to introduce lung cancer screening programs. Japan has had lung cancer screening in place since 1987, offering annual checks to people aged 40 years or older with screening done on a voluntary basis (anyone who would like to be screened can be referred by their primary physician or they can be screened during routine medical check-ups). Taiwan introduced a screening programme in 2020, covering individuals 50-80 years of age, with either a history of smoking or a history of lung cancer in their family. Both Australia and England announced this year that they will introduce targeted lung cancer screening programmes and there are advocacy movements calling for its adoption in many other countries.
How to ensure screening programs are fit for purpose – striking a balance
Introducing screening programs is all about striking a balance – governments have to consider the potential benefit that they bring and also the possible challenges. For example, chest x-rays for lung cancer are shown to generate false-positive rates that are in the range of 5% to 10% per exam, which may result in unnecessary invasive diagnostic procedures.
There is also stigma and fear associated with lung cancer which can prevent people from seeking help early in and utilising screening – contributing to late diagnosis and poorer outcomes. The negative association of lung cancer with smoking also can affect the efforts driven by patient groups and advocates to improve disease awareness and funding for patient support.
This leaves us thinking, with more countries due to introduce lung cancer screening programmes, it is crucial that healthcare systems and the cancer care community are equipped to deal with both the many benefits that lung cancer screening provides but also challenges that patients may face in the process.
Empowering patients through the screening process
The expansion of screening further increases the need to ensure patients are provided with accurate information. Patient support is incredibly important since the cancer pathway can be a complex web to navigate. There are several approaches that can be taken to improve patient support in this process.
Strengthening patient-provider communication channels and reducing the use of medical jargon. Studies show that patient’s lack of knowledge and health literacy presents a significant barrier to their experience. Having more patient-centred communication, with the provider being more attentive to the patients concerns and helping facilitate them in the process, is associated with an increased uptake of cancer screening.
Addressing the fear and stigma. It is found that smokers are more likely to avoid lung cancer-related information, due to fear and stigma it brings upon them. Providers should support people interested in undergoing lung cancer screening and encourage them regardless of their smoker status.
Tackle inequalities in cancer screening. Screening uptake has been consistently found to be lower amongst harder to reach and deprived communities. Targeted outreach to these communities can help widen access to screening programs.
For many, screening is only the first step. This is when it’s important to have a clear path to secondary care where a full diagnosis and options for treatment are provided. Increasing workforce capacity to support people through the diagnostic pathways is essential to realising the benefits of screening.
People at risk of lung cancer need to be encouraged to engage with, not scared away from, the system. They need the support of primary care professionals and the wider healthcare system to enable them to make sense of the options available to them. Some communities are already taking this on board. For example, in some Brazilian municipalities, as a way to curb the inequalities in access, they have introduced mobile screening clinics in communities, which has expanded the reach of screening to remote areas. Some cities in the UK are introducing Targeted Lung Health Checks, language explicitly used to deter the fears associated with cancer screening, to encourage those at higher-risk to be screened in accessible locations.
Screening is an incredible tool that we have in our hands; but introducing screening programmes alone will not be enough to tackle lung cancer – alongside these programmes, support for patients is paramount. Countries need to ensure in introducing screening programmes that they are mindful of the fear and stigma surrounding lung cancer; that they don’t overlook hard to reach communities and that they have the workforce in place to guide people through the process. Only by taking a wholistic approach to screening will we be able to reap the huge rewards it offers in early diagnosis and survival.