A manifesto-appeal to “raise awareness among the population at risk and the Italian and European political class on the need to include lung cancer screening” with low-dose CT “among the essential screenings. It is not invasive, it is no longer expensive , and it should be accessible to all who can benefit from it. ” Giorgio Vittorio Scagliotti, director of the Division of Medical Oncology at the University of Turin, thus summarizes the message he intends to launch with the ‘PolmoniAmo Italian Manifesto’, presented today in Milan and created with the support of AstraZeneca. A message addressed to several recipients, including the Italian Parliament, “which is called upon to a civic duty: to facilitate all those initiatives that tend to allow access to early diagnosis methods to ever wider sections of the population, eliminating barriers” existing. The manifesto was drawn up by clinicians who work every day in taking care of patients with lung cancer. “We call the national and regional institutions together with the scientific communities to a call to action – reads the text – in order to guarantee the right to access to screening for Italian citizens at high risk (by age and by tobacco exposure) to develop the lung cancer, through the inclusion of screening within the essential levels of assistance (Lea) in the same way as cervical, colorectal and breast cancer screening programs “. “I think that, even on the eve of the Italian Cancer Plan, among the objectives that are identified and with the resources that are also allocated through the National Recovery and Resilience Plan (Pnrr), one can address a targeted action because the screening of the lung becomes the heritage of our Italian health policy “, says Elena Carnevali, member of the Social Affairs Commission of the Chamber. This neoplasm, observes Scagliotti who is scientific coordinator of ‘PolmoniAmo’ together with his colleague Ugo Pastorino, director of thoracic surgery of the Irccs National Cancer Institute (Int) in Milan, “has so far received less attention than others, also because of the stigma social, attributable to the history of smoking in the majority of patients. Low-dose TAC represents a promising life-saving strategy, but to date is not part of clinical practice and secondary prevention programs reimbursed by the national health service. It is estimated that the population eligible for lung screening, according to international guidelines, is between 600 thousand and 800 thousand Italians. With the manifesto we want to promote a cultural change “. Furthermore, adds Scagliotti, “we want to build a new collaborative model, creating a path that offers tools and resources for the activation of secondary prevention programs throughout the territory, involving in particular family doctors. Anti-smoking centers must also be implemented. To achieve these objectives, funds are needed, which can be recovered from the NRP “. Meanwhile, we look at the data that may arrive from the Italian lung screening network (Risp) in support of the importance of implementing this tool. With the Sostegni-bis Decree Law, 2 million euros were disbursed for the two-year period 2021-2022 to support the first national experimental lung screening program. Thanks to the funding, the Ministry of Health and the Regions have established the Resp. “This is the first free early diagnosis program for lung cancer – explains Pastorino – It is aimed at people between the ages of 55 and 75, who have been consuming a pack of cigarettes a day for more than 30 years. Even the strong can participate. smokers who have quit for less than 15 years. 19 centers with high multidisciplinary clinical competence are involved throughout the territory “. The potential of screening, highlights the specialist, “extends beyond cancer prevention, allowing the early identification of other smoking-related diseases, such as chronic obstructive pulmonary disease and heart disease”. The low-dose CT scan “allows us to calculate the degree of calcification of the coronary arteries, directly proportional to the risk of heart attack or coronary artery stenosis. It is therefore also possible to obtain an evaluation of the cardiovascular risk”. “We must exploit all the progress accumulated in these years, including the development of new technologies for automated CT analysis, which help to avoid problems such as false positives and unnecessary interventions or for diseases that would not lead to any damage. The Network serves to make everyone start from the highest level of knowledge and of course it will also serve the ministry to understand in 2-3 years how effective screening is and decide if in high-risk subjects this can be a reimbursable procedure “.” By 2022 – adds Carnevali – the European Commission will present a proposal for update the Council of Europe recommendation on cancer screening, precisely to ensure greater correspondence with the most recent scientific data. The possibility of applying targeted screening not only to breast, cervical and colorectal cancer, but also to prostate, lung and gastric cancer will be evaluated. The time couldn’t be better to call for more attention to lung cancer. The early detection of the disease through screening, on an experimental and study basis in our legal system, represents an example of the importance of secondary prevention which, together with the fight against smoking, determines lives saved, more quality of life and effectiveness in the paths of care, in addition to the sustainability of the health systems of tomorrow “. It is a” challenge with a strong ethical and moral significance “, Scagliotti underlines,” and we cannot be dismissed in the face of evidence such as the one we have accumulated over the last 20 years . But the level of communication must be increased. We need to go to shopping centers “in people’s daily lives. How often should lung screening be done?” The real bet – says Pastorino – is to do it based on risk, not to do everything the same for everyone, but a different strategy that includes an annual frequency for all those with a very high risk over a longer interval, even 3-4 years, for those with a very low risk. In this way we could improve the cost-benefit of a screening strategy from all points of view. “The fundamental point, concludes Scagliotti,” is to get to diagnose the disease first. And this will produce, without doing anything, a doubling of the 5-year survival. And then, for that number of patients who are still diagnosed at an advanced stage, act on improving survival “.
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