With 338,000 EU-deaths annually, lung cancer is a devastating problem. CT screening has the potential to prevent ten-thousands of lung cancer deaths annually. The positive results of the Dutch-Belgian screening trial (NELSON), with relatively low referral rates, and the NLST in the USA provided conclusive evidence. However, implementation is likely to be limited, slow and of variable quality throughout Europe, and current guidelines could easily require up to 25 million CT screens annually. The most optimal strategy in risk-based lung-thoracic screening is still unknown regarding the optimal and most cost-effective (e.g., targeted) strategy 1) to recruit, 2) to integrate smoking cessation and co-morbidity reducing services, and 3) to determine the (risk-based) screening interval. Personalised regimens based on the baseline CT result can potentially retain 85% of the mortality reduction achievable through screening at 45% less screens, thus potentially saving much unnecessary harm associated with screening, and 0.5-1 billion Euros per year. The heart of 4-IN-THE-LUNG-RUN is a randomised controlled trial amongst 24,000 individuals evaluating whether it is safe to have risk-based less intensive screening intervals after a negative baseline CT. This proposal will form the evidence base for risk-based lung cancer screening with huge benefits for the EU, on health outcomes, cost savings, and innovation in the long run.
The aim of the project is to develop an optimal low dose CT lung cancer screening programme for high-risk European citizens, and to substantially reduce unnecessary harms, while maintaining the huge benefits of lung cancer screening, through a risk-based personalised screening strategy. Also, demonstrating potential to improve health outcomes and equity across Europe.