Challenges in introducing lung cancer screening outlined by NCCP

There is a need for “considerable further work” to be completed before a decision on whether to introduce lung cancer screening in Ireland is made, according to the former Assistant National Director/Director of Public Health at the National Cancer Control Programme (NCCP). Dr Marie Laffoy, who has since retired, was writing to Mr Michael Conroy, Principal Officer in the Cancer Bloods and Organs Policy division of the Department of Health at the end of 2018 in relation to the Irish Cancer Society’s (ICS) position paper on lung cancer. She wrote that work that needs to be undertaken includes the timing of conducting a health technology assessment and a “cost-effectiveness assessment on lung cancer screening”.

“Challenges have been identified in all the trials, and these would need to be sorted,” according to Dr Laffoy.

Identifying the population at risk is a major challenge, she wrote. These include asymptomatic smokers aged between 55 and 70 with a 30-pack year history and ex-smokers who stopped smoking for a number of years.

“Defining the population denominator is difficult but critical,” stated Dr Laffoy. She also underlined the need for investment in infrastructures, equipment, and staff.

Dr Laffoy later forwarded summaries she wrote of two presentations delivered at the 2019 British Thoracic Oncology Group (BTOG) meeting delivered by Prof Harry de Koning, author of the NELSON Trial, and Prof Bob Steele, Chair of the UK National Screening Committee. The NELSON study found that lung cancer screening showed a 26 per cent mortality reduction in men and considerable reduction in false positives compared to previous trials.

“That said, both of the presenters acknowledged that there is a lot of work to be done at European level to bring the impact of the trial into a population-based screening programme,” according to Dr Laffoy.

The Minister for Health Simon Harris established the National Screening Advisory Committee in 2019 to advise on all new proposals for population-based screening programmes and revisions to existing programmes.