Positionspapier zur Implementierung eines nationalen organisierten Programms in Deutschland zur Früherkennung von Lungenkrebs in Risikopopulationen mittels Low-dose-CT-Screening inklusive Management von abklärungsbedürftigen Screeningbefunden

Zusammenfassung

Der Prozess zur Implementierung der Lungenkrebsfrüherkennung mit Niedrigdosis-CT (LDCT) in Deutschland hat in den letzten Jahren deutlich an Dynamik gewonnen. Es wird erwartet, dass der von den Fachgesellschaften kommentierte Referentenentwurf des Bundesministeriums für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz (BMUV) zur Lungenkrebsfrüherkennung noch bis Ende 2023 in Kraft tritt. Basierend auf dieser Verordnung wird der Gemeinsame Bundesausschuss (G-BA) zeitnah ein Programm zur Lungenkrebsfrüherkennung mit LDCT aufsetzten. In diesem Positionspapier stellen die im Lungenkrebsscreening beteiligten Fachgesellschaften erstmals konkrete Eckpunkte für ein einheitliches, strukturiertes und qualitätsgesichertes Früherkennungsprogramm für Lungenkrebs in Deutschland vor, um zu diesem Prozess konstruktiv beizutragen.

Abstract

The process of implementing early detection of lung cancer with low-dose CT (LDCT) in Germany has gained significant momentum in recent years. It is expected that the ordinance of the Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) on the early detection of lung cancer, which has been commented on by the professional societies, will come into effect by the end of 2023. Based on this regulation, the Federal Joint Committee (G-BA) will set up a program for early lung cancer detection with LDCT in the near future. In this position paper, the specialist societies involved in lung cancer screening present key points for a uniform, structured and quality-assured early detection program for lung cancer in Germany to make a constructive contribution to this process.

Citation Format

• Vogel-Claussen J, Blum TG, Andreas S et al. Position paper on the implementation of a nationally organized program in Germany for the early detection of lung cancer in high-risk populations using low-dose CT screening including the management of screening findings requiring further workup. Fortschr Röntgenstr 2024; 196: DOI 10.1055/a-2178-2846

Schlüsselwörter

Lungenkrebs-Screening - Niedrigdosis-Computertomographie - Organisiertes Früherkennungsprogramm - Rundherd-Management

Key words

Lung Cancer Screening - Low-dose Computed Tomography - Organized Early Detection Program - Nodule Management

^* geteilte Erstautorenschaft

^** geteilte Letztautorenschaft

Publication History

Article published online:
10 October 2023

• Literatur

• 1 International Agency for Research on Cancer, World Health Organization. Cancer fact sheets. 2022 Im Internet (Stand 22.09.2023)
• 2 Zentrum für Krebsregisterdaten, Robert Koch Institut. Lungenkrebs (Bronchialkarzinom). 2022 Im Internet (Stand 22.09.2023)
• 3 Luengo-Fernandez R, Leal J, Gray A. et al. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 2013; 14: 1165-1174
• 4 Ellis J. The impact of lung cancer on patients and carers. Chron Respir Dis 2012; 9: 39-47
• 5 Bonney A, Malouf R, Marchal C. et al. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8: Cd013829
• 6 Aberle DR, Adams AM, Berg CD. et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409
• 7 de Koning HJ, van der Aalst CM, de Jong PA. et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020; 382: 503-513
• 8 Field JK, Vulkan D, Davies MPA. et al. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. Lancet Reg Health Eur 2021; 10: 100179
• 9 Hunger T, Wanka-Pail E, Brix G. et al. Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11
• 10 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF). Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms, Langversion 2.1, AWMF-Registernummer: 020/007OL. 2022 Im Internet (Stand 22.09.2023)
• 11 Herth FJF, Reinmuth N, Wormanns D. et al. [Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-dose CT]. Pneumologie 2019; 73: 573-577
• 12 Kauczor HU, Baird AM, Blum TG. et al. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30: 3277-3294
• 13 European Respiratory Society. Open letter – Increasing the early diagnosis of lung cancer in Europe: an essential milestone to tackle the biggest cancer killer. 2022 Im Internet (Stand 22.09.2023)
• 14 Institute for Quality and Efficiency in Health Care. Extracts. In: Lung cancer screening with low-dose computed tomography: IQWiG Reports – Commission No S19-02. Cologne (Germany): Institute for Quality and Efficiency in Health Care (IQWiG). © IQWiG (Institute for Quality and Efficiency in Health Care); 2020. Im Internet (Stand 22.09.2023)
• 15 Bundesamt für Strahlenschutz. Bericht Lungenkrebsfrüherkennung mittels LDCT – Wissenschaftliche Bewertung des Bundesamtes für Strahlenschutz gemäß § 84 Absatz 3 Strahlenschutzgesetz. 2021 Im Internet (Stand 22.09.2023)
• 16 Bundesministerium für Umwelt, Naturschutz, nukleare Sicherheit und Verbraucherschutz. Lungenkrebs-Früherkennungs-Verordnung (LuKrFrühErkV). Referentenentwurf einer Verordnung über die Zulässigkeit der Anwendung der Niedrigdosis-Computertomographie zur Früherkennung von Lungenkrebs bei Rauchern. 2023 Im Internet (Stand 22.09.2023)
• 17 Treskova M, Aumann I, Golpon H. et al. Trade-off between benefits, harms and economic efficiency of low-dose CT lung cancer screening: a microsimulation analysis of nodule management strategies in a population-based setting. BMC Med 2017; 15: 162
• 18 Hofer F, Kauczor HU, Stargardt T. Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach. Lung Cancer 2018; 124: 189-198
• 19 Pastorino U, Silva M, Sestini S. et al. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol 2019; 30: 1162-1169
• 20 Doroudi M, Pinsky PF, Marcus PM. Lung Cancer Mortality in the Lung Screening Study Feasibility Trial. JNCI Cancer Spectr 2018; 2: pky042
• 21 Paci E, Puliti D, Lopes Pegna A. et al. Mortality, survival and incidence rates in the ITALUNG randomised lung cancer screening trial. Thorax 2017; 72: 825-831
• 22 Wille MM, Dirksen A, Ashraf H. et al. Results of the Randomized Danish Lung Cancer Screening Trial with Focus on High-Risk Profiling. Am J Respir Crit Care Med 2016; 193: 542-551
• 23 Infante M, Cavuto S, Lutman FR. et al. Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. Am J Respir Crit Care Med 2015; 191: 1166-1175
• 24 Becker N, Motsch E, Trotter A. et al. Lung cancer mortality reduction by LDCT screening – Results from the randomized German LUSI trial. Int J Cancer 2020; 146: 1503-1513
• 25 Patz Jr EF, Pinsky P, Gatsonis C. et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med 2014; 174: 269-274
• 26 Ten Haaf K, van Rosmalen J, de Koning HJ. Lung cancer detectability by test, histology, stage, and gender: estimates from the NLST and the PLCO trials. Cancer Epidemiol Biomarkers Prev 2015; 24: 154-161
• 27 Gonzalez Maldonado S, Motsch E, Trotter A. et al. Overdiagnosis in lung cancer screening: Estimates from the German Lung Cancer Screening Intervention Trial. Int J Cancer 2021; 148: 1097-1105
• 28 Meza R, Jeon J, Toumazis I. et al. Evaluation of the Benefits and Harms of Lung Cancer Screening With Low-Dose Computed Tomography: Modeling Study for the US Preventive Services Task Force. JAMA 2021; 325: 988-997
• 29 Li M, Zhang L, Charvat H. et al. The influence of postscreening follow-up time and participant characteristics on estimates of overdiagnosis from lung cancer screening trials. Int J Cancer 2022; 151: 1491-1501
• 30 Rampinelli C, De Marco P, Origgi D. et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-benefit analysis. BMJ 2017; 356: j347
• 31 Nekolla EA, Brix G, Griebel J. Lung Cancer Screening with Low-Dose CT: Radiation Risk and Benefit-Risk Assessment for Different Screening Scenarios. Diagnostics (Basel) 2022; 12
• 32 Brain K, Lifford KJ, Carter B. et al. Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial. Thorax 2016; 71: 996-1005
• 33 Rasmussen JF, Siersma V, Pedersen JH. et al. Psychosocial consequences in the Danish randomised controlled lung cancer screening trial (DLCST). Lung Cancer 2015; 87: 65-72
• 34 van den Bergh KA, Essink-Bot ML, Borsboom GJ. et al. Long-term effects of lung cancer computed tomography screening on health-related quality of life: the NELSON trial. Eur Respir J 2011; 38: 154-161
• 35 van den Bergh KA, Essink-Bot ML, Borsboom GJ. et al. Short-term health-related quality of life consequences in a lung cancer CT screening trial (NELSON). Br J Cancer 2010; 102: 27-34
• 36 Gareen IF, Duan F, Greco EM. et al. Impact of lung cancer screening results on participant health-related quality of life and state anxiety in the National Lung Screening Trial. Cancer 2014; 120: 3401-3409
• 37 Williamson S, Patterson J, Crosby R. et al. Communication of cancer screening results by letter, telephone or in person: A mixed methods systematic review of the effect on attendee anxiety, understanding and preferences. Prev Med Rep 2019; 13: 189-195
• 38 Jonas DE, Reuland DS, Reddy SM. et al. Screening for Lung Cancer With Low-Dose Computed Tomography: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 198. AHRQ Publication No. 20-05266-EF-1. Rockville (MD): Agency for Healthcare Research and Quality; 2021. Im Internet (Stand 22.09.2023)
• 39 Kaaks R, Delorme S. Lung Cancer Screening by Low-Dose Computed Tomography – Part 1: Expected Benefits, Possible Harms, and Criteria for Eligibility and Population Targeting. Rofo 2021; 193: 527-536
• 40 Knoke JD, Shanks TG, Vaughn JW. et al. Lung cancer mortality is related to age in addition to duration and intensity of cigarette smoking: an analysis of CPS-I data. Cancer Epidemiol Biomarkers Prev 2004; 13: 949-957
• 41 Vlaanderen J, Portengen L, Schuz J. et al. Effect modification of the association of cumulative exposure and cancer risk by intensity of exposure and time since exposure cessation: a flexible method applied to cigarette smoking and lung cancer in the SYNERGY Study. Am J Epidemiol 2014; 179: 290-298
• 42 Moyer VA. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 160: 330-338
• 43 Krist AH, Davidson KW, Mangione CM. et al. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2021; 325: 962-970
• 44 Hüsing A, Kaaks R. Risk prediction models versus simplified selection criteria to determine eligibility for lung cancer screening: an analysis of German federal-wide survey and incidence data. Eur J Epidemiol 2020; 35: 899-912
• 45 Behr CM, Oude Wolcherink MJ, MJ IJ. et al. Population-Based Screening Using Low-Dose Chest Computed Tomography: A Systematic Review of Health Economic Evaluations. Pharmacoeconomics 2023; 41: 395-411
• 46 Toumazis I, de Nijs K, Cao P. et al. Cost-effectiveness Evaluation of the 2021 US Preventive Services Task Force Recommendation for Lung Cancer Screening. JAMA Oncol 2021; 7: 1833-1842
• 47 Ten Haaf K, Tammemägi MC, Bondy SJ. et al. Performance and Cost-Effectiveness of Computed Tomography Lung Cancer Screening Scenarios in a Population-Based Setting: A Microsimulation Modeling Analysis in Ontario, Canada. PLoS Med 2017; 14: e1002225
• 48 UK National Screening Committee. UK NSC screening recommendation: Adult Lung cancer screening programme. 2022 Im Internet (Stand 22.09.2023)
• 49 Morgan H, Baldwin DR. Important parameters for cost-effective implementation of lung cancer screening. Br J Radiol 2023; 20220489
• 50 Balata H, Ruparel M, OʼDowd E. et al. Analysis of the baseline performance of five UK lung cancer screening programmes. Lung Cancer 2021; 161: 136-140
• 51 Vogel-Claussen J, Lasch F, Bollmann BA. et al. Design and Rationale of the HANSE Study: A Holistic German Lung Cancer Screening Trial Using Low-Dose Computed Tomography. Rofo 2022; 194: 1333-1345
• 52 Duell M, Wiethege T. Das erweiterte Vorsorgeangebot (EVA) zur Lungenkrebsfrüherkennung – Update 2019. DGUV Forum 2020; 15-17
• 53 Blum TG, Morgan RL, Durieux V. et al. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61
• 54 Deutsche Krebsgesellschaft. OncoMap. 2023 Im Internet (Stand 22.09.2023)
• 55 Deutsche Krebsgesellschaft. Jahresbericht der zertifizierten Lungenkrebszentren. Kennzahlenauswertung 2022. Auditjahr 2021/Kennzahlenjahr 2020. 2022 Im Internet (Stand 22.09.2023)
• 56 American College of Radiology Committee on Lung-RADS. Lung-RADS Assessment Categories 2022. 2022 Im Internet (Stand 22.09.2023)
• 57 Oudkerk M, Devaraj A, Vliegenthart R. et al. European position statement on lung cancer screening. Lancet Oncol 2017; 18: e754-e766
• 58 Tanner NT, Kanodra NM, Gebregziabher M. et al. The Association between Smoking Abstinence and Mortality in the National Lung Screening Trial. Am J Respir Crit Care Med 2016; 193: 534-541
• 59 Crosbie PA, Balata H, Evison M. et al. Implementing lung cancer screening: baseline results from a community-based 'Lung Health Check' pilot in deprived areas of Manchester. Thorax 2019; 74: 405-409
• 60 Bach PB, Gould MK. When the average applies to no one: personalized decision making about potential benefits of lung cancer screening. Ann Intern Med 2012; 157: 571-573
• 61 International Association for the Study of Lung Cancer. United Kingdom-Based Smoking Cessation Program Reports That 30 Percent of Support in a Lung Cancer Screening Program: The Yorkshire Enhanced Stop Smoking Study (YESS). 2022 Im Internet (Stand 22.09.2023)
• 62 Evans WK, Gauvreau CL, Flanagan WM. et al. Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model. CMAJ Open 2020; 8: E585-e592
• 63 Fucito LM, Czabafy S, Hendricks PS. et al. Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco. Cancer 2016; 122: 1150-1159
• 64 American Lung Association. Smoking Cessation Interventions and Lung Cancer Screening. 2019 Im Internet (Stand 22.09.2023)
• 65 Herth FJF, Reinmuth N, Wormanns D. et al. [Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-dose CT]. Pneumologie 2019; 73: 573-577
• 66 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. S3-Leitlinie Rauchen und Tabakabhängigkeit: Screening, Diagnostik und Behandlung. AWMF-Register Nr. 076-006. 2021 Im Internet (Stand 22.09.2023)
• 67 Rabenstein A, Aydin D, Lochbuhler K. [Smoking cessation interventions in clinical practice]. MMW Fortschr Med 2021; 163: 32-34
• 68 Ministry of Health New Zealand. The New Zealand Guidelines for Helping People to Stop Smoking. 2021 Im Internet (Stand 22.09.2023)
• 69 Kastaun S, Viechtbauer W, Leve V. et al. Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice – ABC versus 5As. ERJ Open Res 2021; 7