Authors' objectives: According to the most recent figures, nearly 8900 new lung cancers are diagnosed every year in Belgium, and about 5850 patients die from the disease. As the second most common cancer in men and the third most common in women, lung cancer has a significant impact on the health care system and on society as a whole. In individuals with an increased risk profile, it can be detected – and, hence, treated – at an early stage through medical imaging with a low-dose CT scan. This screening greatly improves prognosis and makes it possible to avoid more severe, less effective treatments. However, as with any screening programme, there are also potential drawbacks, such as false-positive results and overdiagnosis. This study aims to investigate the added value of a potential screening programme for lung cancer in Belgium. This Health Technology Assessment (HTA) will allow us to weigh its benefits against its drawbacks. Specifically, we will evaluate: - Effectiveness and safety - Economic aspects, in terms of cost-effectiveness and budget impact Ethical and organisational aspects of a potential lung cancer screening programme will also be discussed

Authors' recommendations: • Lung cancer is often diagnosed at an advanced stage. Low-dose CT screening of (former) smokers at high risk of lung cancer is a strategy to detect the disease at an early stage. In this way, treatment is less invasive and deaths are reduced. • Before a screening programme is organised by the government, a thorough assessment of its effectiveness, safety and cost-effectiveness is essential. KCE was asked to conduct this evaluation. • The KCE conducted systematic literature reviews and relied on Belgian data. It organised meetings with doctors involved in lung cancer care, screening experts and patient associations. • The result of this study shows that lung cancer screening is associated with significant benefits and harms, which are summarised in the figure below. • Lung cancer screening has been shown to reduce lung cancer mortality and overall mortality among the screened high-risk individuals. • On the other hand, some participants receive an indeterminate result where a new scan is performed. There is also sometimes a false-positive result. That 'false alarm' is then revealed by additional, invasive investigations such as biopsies, bronchoscopies, or even surgical procedures. Apart from the unnecessary stress this causes, these procedures can also sometimes cause complications. • In some participants, tumours are treated that would not have evolved or would have evolved very slowly without screening and that would not have posed a danger because the screened person would have died earlier from another disease or from old age (overdiagnosis and overtreatment). • Incidental findings are frequent as a scan of the entire chest is performed. These often trigger additional investigations, and it is currently unclear whether this leads to a positive or negative impact at a population level. • In the long term, there is also a limited risk of cancer from radiation exposure due to repeatedly performing an LDCT. • These benefits and harms are significant. It is therefore important for the government to weigh them up carefully when considering lung cancer screening. And if it decides to launch screening, potential participants should also be given full and clear information about it beforehand. This is an ethical obligation, even if it leads to lower participation rates. Our cost-effectiveness analysis shows that lung cancer screening in Belgium would result in an incremental cost of €77 747/100 participants and 4.64 QALYs gained/100 participants. This amounts to an ICER of €18 530/QALY gained compared to no lung cancer screening. • Lung cancer screening can be cost-effective if the government's willingness to pay is between €20 000 and €30 000 per QALY gained. • A number of variables have a significant impact on the ICER, such as the number of overdiagnoses, price discounts on cancer therapies, the cost of reaching and inviting the target group and the number of participants. • After this assessment of the effectiveness, safety and cost-effectiveness of a possible population screening, other factors such as the impact on the health budget and the healthcare system should also be taken into account in the next phase. This was not part of the scope of the current KCE study, but it can serve as a basis for identifying this impact.

Project Status: Completed

URL for project: https://kce.fgov.be/en/ongoing-and-planned-projects/ongoing-projects/study-2021-02-hta-large-scale-lung-cancer-screening

Year Published: 2024

URL for published report: https://doi.org/10.57598/R379C

URL for additional information: https://kce.fgov.be/en/publications/all-reports/lung-cancer-screening-in-a-high-risk-population

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Belgium

DOI: 10.57598/R379C

Organisation Name: Belgian Health Care Knowledge Centre

Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85

Contact Name: info@kce.fgov.be

Contact Email: info@kce.fgov.be

Copyright: <p>Belgian Health Care Knowledge Centre (KCE)</p>