At the end of the 1990s, the question arose as to whether regular screening with computer tomography could significantly reduce deaths from lung cancer.

Some countries such as the USA or Great Britain have now introduced it.

Why isn't there one in Germany yet?

Pia Heineman

Editor of Nature and Science

  • Follow I follow

Rudolf Kaaks: I assume that it is only a matter of time.

The IQWIG, the institute that weighed the benefits and costs of screening on behalf of the Joint Federal Committee of Health Insurance Funds, presented a positive final report two years ago: the screening is worthwhile.

In addition, a panel of experts from the Federal Office for Radiation Protection (BfS), to which I belonged, checked the safety of the method.

This panel concluded: The screening makes a lot of sense.

For whom?

Certainly not for everyone, not even for every smoker.

In the USA, for example, where screening has been going on for some time, the so-called pack years are used to precisely define the target group.

If a person smoked two packs of cigarettes a day for a period of ten years, he has accumulated 20 pack-years.

If he is also at least 50 and no more than 80 years old, then he will be invited to the screening there.

In the BfS report for screening in Germany, the minimum criteria for suitability for screening are somewhat different: a minimum age of 50 years and a maximum age of 75 years are suggested.

It should also be taken into account how long and how many cigarettes were smoked.

Either at least half a pack a day for 30 years or three quarters of a pack a day for 25 years.

In addition, the suitability for screening takes into account how many years ago the smoker quit.

In the USA, this must not be more than 15 years ago, according to the BfS report no more than 10 years.

Why is the patient's age important - actually only the duration of smoking should be included in the risk assessment, right?

The minimum age is based on the fact that people who are younger than 50 years old, even if they have smoked a lot, usually do not have a sufficiently high risk of lung cancer.

The maximum age has to do with the fact that after the age of 75 you cannot gain many years of life if you discover lung cancer.

At the same time, the risk of overdiagnosis increases significantly with age.

What does that mean exactly?

An example: If a tumor is detected by screening in a 75-year-old and is thus found four years earlier than the tumor would normally have revealed itself, then the risk that the patient will die of another disease in the coming years is very high .

Basically, knowing about the tumor does not bring any benefit to the person.

On the contrary, it even causes damage because the patient has to live with the knowledge of the cancer.

The risk of this overdiagnosis increases greatly with age.

Lung cancer is one of the deadliest cancers in Germany. It is the number one cause of cancer death in men and second only to breast cancer in women. Around 18,000 women and a good 27,000 men die of lung cancer every year.

How far could these numbers be reduced by screening?