Five seconds can be enough to save lungs and heart. This is one of the many messages that arrive at the conclusion of the presentation of the first data of the national screening program for lung cancer with CT scans at low doses of radiation, one year after its departure. We are talking about a free experimental project supported by the Ministry of Health, promoted by the National Cancer Institute of Milan (INT) with the involvement of 18 centers throughout Italy (www.programmarisp.it), which is aimed at heavy smokers among 55 and 75 years old (current or in the past 15 years). Objective: to be able to make an early diagnosis of one of the most frequent tumors in the Italian population (second in men and third in women), caused in most cases by cigarette smoking.
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To date, 15,000 people have voluntarily signed up for the program, half of whom (over 7,000) have been eligible for the programme: 4,560 have already performed the CT scan and the others will perform it by the end of the summer. Overall, the study envisages the recruitment of 10,000 volunteers over an 18-month period. “We want to demonstrate that it is possible to reduce lung cancer mortality in high-risk heavy smokers thanks to low-dose computed tomography screening for early diagnosis and with a smoking cessation program that also includes the administration of the drug cytisine” – explains Ugo Pastorino, Director of the Complex Structure of Thoracic Surgery and coordinator of the RISP program (Italian Pulmonary Screening Network). “And if the data we obtain confirm our hypotheses, the next step will be to stimulate the institutions to include this approach in the essential levels of assistance, thus making both low-dose CT scans and anti-smoking drugs reimbursable with the National Health Service as a preventive measure for those who are at high risk”.
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Early diagnosis and reduction of mortality
In reality, the data demonstrating the effectiveness of CT screening at low doses of radiation already exist, the expert points out: large studies have shown a reduction in lung cancer mortality of 8-26% for men and of 26-61% in women with this method. "Thanks to screening, in fact, it is possible to receive a diagnosis in the initial phase, that is when the tumor is in the first and second stage" - adds Francesco Facciolo, Director of Thoracic Surgery at the Regina Elena Institute in Rome - In these cases the tumor is curable with a decisive intervention and performed in minimally invasive surgery, with a long-term survival of more than 80%”. The problem is that to date in Italy the disease has been discovered in an advanced stage in over seven out of ten cases: ergo, it is necessary to demonstrate that it is possible to reverse these percentages in our country.
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What is low-dose radiation CT scan and what does it reveal besides tumors
The machine used is the Computed Tomography Axial (CT) thoracic spiral, whose images are analyzed with the support of artificial intelligence, which allows to reduce false positives and, therefore, unnecessary interventions. "We also use the latest generation equipment which is extremely quick to perform and, even more importantly, exposure to a minimum dose of radiation, without compromising the quality of the images", explains Nicola Sverzellati, Director of the Radiological Sciences Unit AOU of Parma and Full Professor of the University of Parma. This chest CT scan not only provides information about whether or not cancerous nodules are present, but it provides a lot of other information about the health of the heart, arteries and lungs in general, which can help predict the risk of heart attack, stroke and COPD with years of advance.
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Lung cancer, the differences between women and men
In 2022, an estimated 43,900 new lung cancer diagnoses were estimated, including 14,600 among women. "We are witnessing an increase in cases of disease among the female population" - underlines Silvia Novello, Head of Pulmonary Oncology at the San Luigi Gonzaga in Orbassano and President of WALCE Onlus - Women Against Lung Cancer - "The one and only cause of this given is the increase in smoking. What we are also noticing is that one in ten women starts smoking before the age of 15. In Europe, Italy stands out for one of the highest rates of young smokers”. There are many gender differences that affect the incidence and progression of the disease. How different are the social contexts that can favor the habit of smoking. “For this reason - continues Novello - we need to think about prevention campaigns aimed at different population groups: we cannot think of raising awareness with the same messages and the same strategies for girls aged 11 and women over 50, also because in the latter case the objectives become two, screening and prevention”.
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Cytisine, the anti-smoking drug
As part of the RISP programme, the National Cancer Institute of Milan has also promoted the distribution of cytisine to the centers participating in the project. This drug, until now only available in a galenic formulation, is now available in specially prepared tablets, currently only for administration to study participants. Cytisine is an anti-smoking drug with many advantages, as demonstrated by a study conducted by INT together with the Mario Negri Institute in Milan and the University of Parma: "It is a well-tolerated active ingredient, almost free of side effects and unlike nicotine it does not create addiction – comments Roberto Boffi, Head of Pneumology and the INT Anti-Smoking Centre. “It has a dosage schedule that provides for a 40-day therapy, with smoking cessation scheduled between the 8th and 14th day, divided into several daily intakes due to the short half-life of the active ingredient. However, this limitation can also be its trump card because it replaces the ritual of the cigarette”.
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Puglia, booking of screening is done in the pharmacy
To increase the participation of volunteers in the screening program, Puglia has decided to involve pharmacies. "We involved around 300 to inform the population in a capillary manner and we managed to record a high level of participation - says Domenico Galetta, Head of the SS Department of Medical Oncology for thoracic pathology, John Paul II Cancer Institute of Bari - The smoker who recognizes in the characteristics indicated by the Program, can enroll in the pharmacy and also make an appointment for the CT screening. The other positive aspect – he concludes – is that in half of the cases people also asked to participate in the process of cessation with a high percentage of success ”.
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The list of the 18 centers is on the programmarisp.it website; the hospitals are located in the cities of Pescara, Potenza, Catanzaro, Naples, Parma, Reggio Emilia, Rome, Genoa, Milan, Bergamo, Ancona, Trento, Turin, Bari, Catania, Florence and Padua.